Alerts and Notices
SynopsisFitz-Hugh-Curtis syndrome refers to a condition that occurs during or after a pelvic infection (usually caused by a sexually transmitted infection [STI], eg, gonorrhea or chlamydia). Patients develop a peri-hepatitis causing symptomatology.
This disorder occurs in up to 25% of women who have pelvic inflammatory disease (PID). According to the Centers for Disease Control and Prevention (CDC), approximately 750 000 women a year have PID. The direct pathogenesis from which this emerges is unclear, but some research suggests it may be part of a hyperimmune response to the preceding infection.
Risk factors include similar things that would put one at risk for contracting an STI: multiple sexual partners, lack of barrier protection, younger age, history of prior STI, recent new partner, and immunosuppression.
Patients will often present with acute-onset sharp right upper quadrant pain, worse with inspiration. They may or may not report a recent STI or pelvic infection, as this could be concurrent. Some patients will experience nausea, vomiting, malaise, and fever. The classic right upper quadrant pain in these patients is caused by adhesions of the anterior liver to the abdominal wall.
Most patients are treated presumptively, as unfortunately the only true way to confirm this diagnosis is by identifying the characteristic findings at the time of intra-abdominal exploration (usually by laparoscopy). With this condition, one will find an adhesion band from the liver capsule edge to the abdominal wall or diaphragm.
079.88 – Other specified chlamydial infection
A54.85 – Gonococcal peritonitis
A74.81 – Chlamydial peritonitis
237041005 – Fitz-Hugh-Curtis Syndrome
Differential Diagnosis & Pitfalls
- Pulmonary embolus
- Hepatitis (eg, infection with hepatitis A virus [HAV], HBV, or HCV; drug-induced hepatotoxicity; autoimmune hepatitis; alcoholic hepatitis)
- Ectopic pregnancy