Summary about Disease
Fitz-Hugh-Curtis syndrome (FHCS) is a rare condition characterized by inflammation of the liver capsule (perihepatitis) and surrounding abdominal area, usually occurring in women. It is most commonly associated with pelvic inflammatory disease (PID), particularly infections caused by Chlamydia trachomatis or *Neisseria gonorrhoeae*. While it's related to infection, the primary symptoms involve severe right upper quadrant abdominal pain, rather than the typical symptoms of PID.
Symptoms
Sharp, stabbing pain in the right upper quadrant of the abdomen.
Pain may radiate to the right shoulder or down the right arm.
Pain may worsen with breathing, coughing, or movement.
Fever.
Nausea and vomiting (less common).
Sometimes, symptoms of PID (pelvic pain, vaginal discharge) may also be present, but often are mild or absent.
Causes
Most commonly caused by pelvic inflammatory disease (PID).
Chlamydia trachomatis and *Neisseria gonorrhoeae* are the most frequent causative organisms.
Less commonly, other bacteria may be involved.
The infection spreads from the pelvic organs (uterus, fallopian tubes) to the liver capsule via the peritoneal cavity.
Medicine Used
Antibiotics: Treatment focuses on eradicating the underlying infection causing the PID. Antibiotics are selected based on the likely causative organism(s). Common choices include:
Ceftriaxone (intramuscularly or intravenously)
Doxycycline (orally)
Metronidazole (orally or intravenously) - often added to cover anaerobic bacteria.
Pain Management:
Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief.
In severe cases, opioid analgesics may be required for short-term pain management.
Is Communicable
Fitz-Hugh-Curtis syndrome itself is not directly communicable. However, the underlying sexually transmitted infections (STIs) that cause PID, such as Chlamydia and *Gonorrhea*, are communicable. They are transmitted through sexual contact.
Precautions
Safe Sex Practices: Using condoms consistently and correctly during sexual activity significantly reduces the risk of STIs.
Regular STI Screening: Especially important for sexually active individuals, particularly those with multiple partners.
Prompt Treatment of STIs: If diagnosed with an STI, immediate treatment is essential to prevent complications like PID and FHCS, and to prevent further transmission.
Partner Notification: Inform sexual partners if diagnosed with an STI so they can get tested and treated if necessary.
Avoid Douching: Douching can disrupt the natural balance of bacteria in the vagina and increase the risk of infection.
How long does an outbreak last?
The duration of symptoms varies. With prompt antibiotic treatment, the acute pain can begin to subside within a few days to a week. However, some individuals may experience chronic pain or adhesions (scar tissue) even after the infection is cleared. Chronic pain can persist for weeks, months, or even longer in some cases. The longer the infection is left untreated, the greater the risk of long-term complications.
How is it diagnosed?
Clinical Evaluation: Based on the patient's symptoms (especially right upper quadrant abdominal pain and possible PID symptoms), medical history, and physical examination.
Pelvic Exam: To assess for signs of PID (tenderness, discharge).
STI Testing: Cultures or PCR tests to detect Chlamydia trachomatis and *Neisseria gonorrhoeae* from cervical or urethral swabs.
Blood Tests: Complete blood count (CBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) may be elevated, indicating inflammation. Liver function tests may be normal or mildly elevated.
Imaging Studies:
Ultrasound: To evaluate the pelvic organs and rule out other causes of abdominal pain.
CT Scan or MRI: May be used to visualize the liver capsule and identify adhesions, although these are not always necessary for diagnosis.
Laparoscopy: In some cases, laparoscopy (a minimally invasive surgical procedure) may be necessary to directly visualize the liver capsule and confirm the diagnosis, especially if other diagnostic tests are inconclusive. It allows for visualization of the characteristic "violin string" adhesions.
Timeline of Symptoms
The timeline can vary, but generally follows this pattern:
Initial Infection: Exposure to Chlamydia or *Gonorrhea* (or other causative organism). This can be asymptomatic initially.
PID Development: If the infection is not treated, PID develops (pelvic pain, vaginal discharge, fever). These symptoms may be mild or even absent in some women with FHCS.
Perihepatitis Development: The infection spreads to the liver capsule.
Acute Pain Onset: Sudden onset of sharp, stabbing right upper quadrant abdominal pain. This can occur days to weeks after the initial infection or PID symptoms.
Resolution with Treatment: With appropriate antibiotics, pain typically starts to improve within a few days to a week.
Chronic Pain/Adhesions: In some cases, chronic pain or adhesions may develop, lasting for weeks, months, or even longer.
Important Considerations
Differential Diagnosis: It is crucial to differentiate FHCS from other conditions causing right upper quadrant abdominal pain, such as cholecystitis (gallbladder inflammation), appendicitis, ectopic pregnancy, and liver abscess.
Prompt Diagnosis and Treatment: Early diagnosis and treatment are essential to prevent long-term complications, such as chronic pain and infertility (resulting from PID).
Partner Treatment: It is essential to treat the sexual partners of individuals diagnosed with FHCS (and the underlying STI) to prevent reinfection and further spread of the infection.
Adhesions: Even after successful treatment of the infection, adhesions can form between the liver capsule and surrounding structures, leading to chronic pain. These adhesions are the hallmark of FHCS seen during laparoscopy.
Impact on Fertility: PID can lead to scarring and blockage of the fallopian tubes, increasing the risk of ectopic pregnancy and infertility. Therefore, early diagnosis and treatment of PID are critical for preserving fertility.