Clinical Features of Fitz-Hugh-Curtis Syndrome in the Emergency Department

Abstract

Purpose Fitz-Hugh-Curtis Syndrome (FHCS) is a clinical entity characterized by inflammation of the liver capsule associated with genital tract infection. The aim of this study is to provide physicians with clinical suggestions for diagnostic approaches based on a series of patients who were diagnosed with FHCS. Materials and Methods We conducted a retrospective study of patients who were diagnosed with FHCS after presenting to the emergency department (ED). The symptoms, physical examinations, laboratory findings, radiological findings, and progress of the patients were reviewed. Results During the four-year study period, a total of 82 female patients received a final diagnosis of FHCS in the ED. Chlamydia trachomatis was identified as a pathogen in 89% of the patients. Their clinical characteristics and laboratory findings were described. Fifty-two patients (63.4%) were admitted to the hospital. All of the admitted patients improved after treatment combining antibiotic therapy with conservative care. Conclusion FHCS should be considered as a differential diagnosis for female patients of childbearing age with right upper abdominal pain. Timely diagnosis using biphasic computed tomography (CT) with arterial and portal phases may help ensure adequate medical treatment as well as avoid invasive procedures.

Acute Fitz-Hugh-Curtis Syndrome in a Man due to Gonococcal Infection

“…Some ultrasound abnormalities have been described previously in patients with FHCS, such as fluid collection in the perihepatic or the hepatorenal space (5,14). In these cases, more invasive and expensive procedures are not required, and prompt antibiotic therapy can be curative (3,4,15). Here we describe both a collection of perihepatic fluid and a subcapsular hypoechoic focal lesion, which would be consistent with a subcapsular liquid area or with a localized inflammatory process.…”

“…This clinical presentation leads to frequent misdiagnosis as different gastrointestinal and renal diseases. Acute FHCS is characterized by very nonspecific symptoms, mimicking cholecystitis, biliary colic, appendicitis, liver abscess, duodenal ulcer, pyelonephritis and, less frequently, hepatitis, pleurisy, and herpes zoster infection (3,4). Laboratory findings are usually nonspecific, with elevated WBC, CRP, and ESR.…”

“…Dynamic abdominal CT scan is more sensitive than ultrasound in diagnosis of FHCS (2,16). Typical features include increased capsular or subcapsular enhancement in the arterial phase caused by perihepatic inflammation (3,6). In the chronic development of the disease, laparoscopy remains the definitive diagnostic and therapeutic procedure; evidence of adhesions and their mechanical lysis can provide complete resolution of symptoms (7).…”

“…Fever or urogenital symptoms are rarely present in FHCS. The differential diagnosis can be challenging, and this syndrome might be confused RECEIVED: 10 October 2013; FINAL SUBMISSION RECEIVED: 31 January 2014; ACCEPTED: 28 April 2014 with different gastrointestinal or renal diseases, such as cholecystitis, duodenal ulcer, acute appendicitis, or pyelonephritis (3,4). Acute FHCS can be diagnosed in the early stage through noninvasive methods, such as abdominal ultrasound or computed tomography (CT) scan, and readily treated with antibiotic therapy.…”

Fitz-Hugh-Curtis syndrome lacking typical characteristics of pelvic inflammatory disease

“…Although FHCS is always associated with PID, it may present without signs and symptoms of pelvic inflammation; RUQ and lower abdominal pain coexist in only 32% of patients with FHCS, with RUQ pain the only presenting symptom in 50% of cases 6. Moreover, clinicians should be aware that lower abdominal pain itself may be absent at presentation in more than half of the patients; in a small case series from Japan, Suzuki et al 7 reported pain migrating away from the lower abdomen to the RUQ in eight of nine patients with FHCS.…”