Fitz-Hugh–Curtis Syndrome-rare case reported in NEJM

Dr Francesco Guerra and Dr Diego Coletta, at Ospedali Riuniti Marche Nord, Pesaro, Italy have reported a rare case of Fitz-Hugh–Curtis Syndrome. The case has appeared in the New England Journal of Medicine.

Fitz-Hugh-Curtis syndrome is a rare disorder that occurs almost exclusively in women. It is characterized by inflammation of the peritoneum and the tissues surrounding the liver (perihepatitis). Common symptoms include severe pain in the upper right quadrant of the abdomen, fever, chills, headaches, and a general feeling of poor health (malaise). Fitz-Hugh-Curtis syndrome is a complication of pelvic inflammatory disease (PID), a general term for infection of the upper genital tract in women. Infection is most often caused by Neisseria gonorrhoeae and Chlamydia trachomatis.

According to history, a 62-year-old woman presented to the surgical outpatient clinic with a 3-month history of intermittent abdominal pain in the right upper quadrant. Approximately 4 months before presentation, she had received a diagnosis of and been treated for pelvic inflammatory disease. The signs and symptoms at that time, which included severe lower abdominal pain and purulent vaginal discharge, had resolved with the completion of antibiotic treatment. The physical examination at the current visit was notable for a soft abdomen and moderate tenderness of the right upper quadrant.

The laboratory studies, including a complete blood count and C-reactive protein and liver-function tests, were normal. An ultrasound examination of the abdomen revealed cholelithiasis. A plan for cholecystectomy was made for suspected biliary colic. On laparoscopy, extensive, dense adhesions between the anterosuperior hepatic surface and the abdominal wall were seen (Panels A and B [anterior and superior surfaces of the liver, respectively]).

Sometimes referred to as “violin string–like adhesions,” this finding is characteristic of the Fitz-Hugh–Curtis syndrome, a condition in which perihepatitis develops in association with pelvic inflammatory disease. Perihepatic lysis of adhesions and cholecystectomy were performed. At follow-up 5 months after surgery, the patient was well and had no abdominal pain.

The treatment of Fitz-Hugh-Curtis syndrome is directed toward the specific symptoms that are apparent in each individual. Antibiotic therapy is the mainstay treatment for individuals with Fitz-Hugh-Curtis syndrome along with surgical intervention if required.

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DOI: 10.1056/NEJMicm1813625