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

Abstract

A 23-year-old Japanese woman, previously a commercial sex worker, presented with a 2-day history of right upper quadrant (RUQ) abdominal pain, worse on deep inspiration. She had noticed increased vaginal discharge 2 months earlier and had developed dull, lower abdominal pain 3 weeks prior to presentation. Although pelvic examination and transvaginal ultrasonography revealed neither a tubal nor ovarian pathology, abdominal CT scan with contrast demonstrated early enhancement of the hepatic capsule, a finding pathognomonic for Fitz-Hugh-Curtis syndrome (FHCS). Cervical discharge PCR assay confirmed Chlamydia trachomatis infection. This case highlights that normal gynaecological evaluation may be insufficient to rule out FHCS, for which physicians should have a high index of suspicion when seeing any woman of reproductive age with RUQ pain.

• Authors: Hayato Mitaka, Hidetaka Kitazono, Gautam A Deshpande, Eiji Hiraoka
• Journal: BMJ case reports (BMJ Case Rep) Vol. 2016 (Jun 22 2016) ISSN: 1757-790X [Electronic] England
• PMID: 27335367 (Publication Type: Case Reports, Journal Article)
• Copyright: 2016 BMJ Publishing Group Ltd.

Chemical References

• Anti-Bacterial Agents
• Ceftriaxone
• Doxycycline

Topics

• Abdominal Pain (diagnostic imaging, etiology)
• Adult
• Anti-Bacterial Agents (therapeutic use)
• Ceftriaxone (therapeutic use)
• Chlamydia Infections (diagnosis, drug therapy, microbiology)
• Chlamydia trachomatis (isolation & purification)
• Contact Tracing
• Directive Counseling
• Doxycycline (therapeutic use)
• Drug Therapy, Combination
• Female
• Hepatitis (diagnosis, drug therapy, microbiology)
• Humans
• Pelvic Inflammatory Disease (diagnosis, diagnostic imaging, drug therapy, microbiology)
• Peritonitis (diagnosis, drug therapy, microbiology)
• Sex Work
• Tomography, X-Ray Computed
• Treatment Outcome