Fitz-Hugh–Curtis syndrome

Perihepatic adhesions 2

Fitz-Hugh–Curtis syndrome is a rare complication of pelvic inflammatory disease (PID) characterized by inflammation of the liver capsule and surrounding peritoneum. This condition is named after the American physicians Thomas Fitz-Hugh Jr. and Arthur Hale Curtis, who first described it in the 1930s.

Pathophysiology

Fitz-Hugh–Curtis syndrome occurs when bacteria, typically Neisseria gonorrhoeae or Chlamydia trachomatis, spread from the pelvic organs to the liver capsule. This results in perihepatitis, an inflammation of the tissue surrounding the liver. The exact mechanism of bacterial spread is not fully understood, but it is believed to involve direct extension through the peritoneal cavity or hematogenous dissemination.

Symptoms

The primary symptom of Fitz-Hugh–Curtis syndrome is a sharp, right upper quadrant abdominal pain that may radiate to the right shoulder or arm. This pain is often exacerbated by movement, coughing, or deep breathing. Other symptoms may include:

• Fever
• Nausea
• Vomiting
• Generalized malaise

Diagnosis

Diagnosis of Fitz-Hugh–Curtis syndrome is often challenging due to its nonspecific symptoms. It typically involves a combination of clinical evaluation, laboratory tests, and imaging studies. Key diagnostic steps include:

• Pelvic examination to identify signs of PID
• Laboratory tests to detect Neisseria gonorrhoeae or Chlamydia trachomatis
• Imaging studies such as ultrasound or CT scan to visualize inflammation around the liver

Treatment

The treatment of Fitz-Hugh–Curtis syndrome primarily involves the administration of antibiotics to eradicate the underlying infection. Commonly used antibiotics include:

• Doxycycline
• Azithromycin
• Ceftriaxone

Pain management and supportive care are also important components of treatment. In severe cases, hospitalization may be required.

Prognosis

With appropriate antibiotic treatment, the prognosis for Fitz-Hugh–Curtis syndrome is generally good. Most patients experience significant improvement in symptoms within a few days of starting treatment. However, if left untreated, the condition can lead to chronic pain and complications such as adhesions and infertility.

Related Pages

• Pelvic inflammatory disease
• Neisseria gonorrhoeae
• Chlamydia trachomatis
• Perihepatitis
• Thomas Fitz-Hugh Jr.
• Arthur Hale Curtis