Fitz-Hugh-Curtis Syndrome

What is Fitz-Hugh-Curtis Syndrome?

Fitz-Hugh-Curtis syndrome is an unusual sexually transmitted disease which can be a secondary medical problem that may arise in addition to infections of the reproductive system. These kinds of infections are likely to extend upward, for instance, from the vagina going up to involve the uterus. Roughly about 15 to 30% of females suffering from pelvic inflammatory disease will develop the above syndrome; more commonly affected are the sexually active female adolescents due to the immaturity of their reproductive anatomy. Then again, foreign records show it may arise in women with no pelvic infections and infrequently in men also.


In this syndrome, the microorganisms mostly originating from an infection of the pelvis extend throughout the abdominal region which results to inflammation of the tissues that border the liver. There is then a development of abnormal tissue connections relating the intra-abdominal wall and the exterior part of the liver. Neisseria gonorrhea and Chlamydia trachomatis are recognized to cause it. In time, these affected areas in between the liver and the abdominal wall become threads of fibrous scars. The affected individual typically reports right upper quadrant pain which is sharp, hyperthermia and queasiness. The treatment of choice is antibiotics in general.

In the year 1920, Stajano described a rare complication regarding a gonococcal infection with liver affectation. The disease was named after Arthur Hale Curtis and Thomas Fitz-Hugh, Jr, the two doctors who fully described the rare condition in medical writing in the year 1930 and 1934, in that order.

Symptoms

Patient enters two stages of the disease; the acute and chronic phases. The syndrome is clinically presented by the following signs and symptoms;

Acute Phase

  • The patient may report of an, abdominal pain and tenderness felt on the right upper quadrant with an acute onset. The pain is described to gradually radiate to the right shoulder and is made worse when a patient breathes, attempts to sneeze, cough and move or other actions which can increase the intra-abdominal pressure. The pain felt is more particular on the area over the bladder. This experience is due to perihepatitis subsequent to transabdominal infection from PID.
  • Affected individuals may also complain of a pleuritic right sided chest pain.
  • General symptoms can also be noted in affected individuals such as nausea and vomiting, hyperthermia, chills, night sweats, headache, mild jaundice and body malaise.

Chronic Phase

  • The chronic phase is clinically presented by an unrelenting pain which is dull in character located on the right upper quadrant, or in some situations, the pain recedes.
  • When a laparoscopic examination is done at some point in the chronic phase of the disease, the result may show stringy-looking adhesions forming in between the anterior liver capsule and the abdominal wall which can be characteristically expressed to bear a resemblance to a violin string.

Causes

The rare disease happens virtually limited to female population, although hardly ever, men can also affected such as a case of a man from Korea. Though the clinical presentation of the disease is akin in both affected males and females, the etiology differs. In females, the fallopian tube which has become infected extends the infection to the liver capsule; as fluid is circulated by way of the paracolic gutter. Usually, the causative agents are gonorrhea and Chlamydia bacteria; however, the latter is presently about 5 times more frequent. These microorganisms can result to cervical mucus thinning, permitting these microorganisms to penetrate into the uterus and fallopian tubes from the vaginal opening and cause inflammation. In males, the syndrome is hypothesized to be hematogenous or due to lymphatic drainage.

Treatment

Treatment for Fitz Hugh Curtis syndrome covers early establishment of the diagnosis and proper treatment of the primary cause.

  • Patients are usually prescribed with antibiotics with appropriate duration which are directed purposely at the microorganisms causing the disease. The doctor’s prescription will depend on the findings of the culture.
  • Partners of the affected individuals are also required to undergo treatment.
  • Sexual intercourse must be avoided until the infection is completely cleared away.
  • Every so often, nonsteroidal anti-inflammatory medications and analgesics may be administered, and;
  • Infrequently, division of adhesions may need to be done laparoscopically.

Diagnosis

Physical Examination

An upper abdominal pain may imply the clinical finding, together with the presence of an infection of the pelvis. When the area over the anterior costal margin is auscultated, a friction rub is heard which can be expressed as someone walking on a snow.

Cotton swabs

Cotton swabs must be utilized to take a sample of bacteria in order to find out whether the causative agent is Chlamydia or gonorrhea.

Other investigations

  • Hematologic exams may reveal elevations in white blood cell count and in erythrocyte sedimentation rate or ESR
  • Urinalysis must also be done.
  • To rule out familiar conditions which also produce analogous manifestations, such as hepatitis, gallstones, kidney stones and peptic ulcer, an abdominal ultrasound and a CT scan may be necessary. Chest x-ray may also be performed to exclude the possibility of pneumonia.
  • Once the result of laparoscopy is out, the diagnosis becomes final. In this procedure, a camera is inserted inside the abdomen. Affectations to the fallopian tube and to the adjacent organs in the reproductive system as well as the adhesions can be revealed. In the course of the acute stage, the peritoneum, as well as the anterior liver capsule is inflamed; grey-colored exudates can be noted surrounding the area, which are granular in form. The patient is assumed to be in the chronic phase when violin string adhesions are spotted on the anterior capsule of the liver.

Fitz Hugh Curtis Syndrome in Men

The condition is really a very unusual complication of genito-urinary gonococcal infection in the male population. In 1970, the first male case was reported by Kimball and Knee.

Another male case involved a 25-year-old Nigerian in 1971 who was diagnosed to have gonococcal septicemia complicated by polyarthritis and hepatitis. The said patient had a month of RUQ pain history, jaundice, fever and painful joint swellings. A month before the beginning of the manifestations, the patient confessed to have a sexual intercourse with a prostitute. Upon examination, the patient was hot, appeared very unwell mildly jaundiced. In the case of this patient, his hepatitis and his gonococcal arthritis originated from the septicemia.

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