Chlamydia trachomatis-induced Fitz-Hugh–Curtis syndrome: a case report

BMC Research Notes, Jan 2017

Background Fitz-Hugh–Curtis syndrome is defined as perihepatitis associated with pelvic inflammatory disease. Chlamydia trachomatis is one of its most common aetiologies. This syndrome usually presents with right upper quadrant abdominal pain mimicking other hepatobiliary and gastrointestinal pathologies, hence, posing a diagnostic dilemma in settings with limited diagnostic tools. Case report A 32 year old African female presented with acute right upper quadrant abdominal pain and vaginal discharge, for which she had previously received treatment in another health center with no improvement. Clinical and laboratory findings were suggestive of Fitz-Hugh–Curtis syndrome. Five days after treatment with oral doxycycline, the patient showed marked clinical improvement. Conclusion Fitz-Hugh–Curtis syndrome is a common cause of right upper quadrant pain which is often under diagnosed in poor communities. Hence, it should be included as a differential diagnosis in patients presenting with right upper quadrant pain, especially in females of reproductive age.

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Chlamydia trachomatis-induced Fitz-Hugh–Curtis syndrome: a case report

Ekabe et al. BMC Res Notes Chlamydia trachomatis-induced Fitz-Hugh-Curtis syndrome: a case report Cyril Jabea Ekabe Jules Kehbila Tsi Njim Benjamin Momo Kadia Celestine Ntemlefack Tendonge Gottlieb Lobe Monekosso Background: Fitz-Hugh-Curtis syndrome is defined as perihepatitis associated with pelvic inflammatory disease. Chlamydia trachomatis is one of its most common aetiologies. This syndrome usually presents with right upper quadrant abdominal pain mimicking other hepatobiliary and gastrointestinal pathologies, hence, posing a diagnostic dilemma in settings with limited diagnostic tools. Case report: A 32 year old African female presented with acute right upper quadrant abdominal pain and vaginal discharge, for which she had previously received treatment in another health center with no improvement. Clinical and laboratory findings were suggestive of Fitz-Hugh-Curtis syndrome. Five days after treatment with oral doxycycline, the patient showed marked clinical improvement. Conclusion: Fitz-Hugh-Curtis syndrome is a common cause of right upper quadrant pain which is often under diagnosed in poor communities. Hence, it should be included as a differential diagnosis in patients presenting with right upper quadrant pain, especially in females of reproductive age. Fitz Hugh-Curtis syndrome; Chlamydia trachomatis; Resource-limited setting - Background Fitz-Hugh–Curtis syndrome (FHCS), characterized by perihepatic capsulitis and pelvic inflammatory diseases (PID) [1–3] usually presents with right upper quadrant (RUQ) pain and is frequently associated with symptoms of PID (fever, lower abdominal pain, vaginal discharge) [4]. The RUQ pain is typically sharp, pleuritic, exacerbated by movement, and often referred to the right shoulder or to the inside of the right arm. It may be associated with nausea, vomiting, hiccupping, chills, fever, night sweats, headache, and malaise [4]. This pain is due to adhesion of the anterior hepatic surface to the abdominal wall [4]. RUQ pain is a common presentation of hepatobiliary, gastrointestinal and urogenital diseases like: hepatitis, liver abscess, sub-phrenic abscess, cholecystitis, appendicitis and pyelonephritis [5]. 4 Health and Human Development (2HD) Research Group, Douala, Chlamydia trachomatis is among the most common causes of PID worldwide and in Cameroon [1, 6]. Chlamydia trachomatis and Neisseria gonorrhoea have been identified as the main aetiologies of PID and FHCS worldwide [7, 8]. FHCS is common among women of child bearing age, with a prevalence of 12–14% in women with PID [5]. Diagnosis of FHCS poses diagnostic problems because of its similar presentation with many of the aforementioned pathologies, especially in resource-limited settings where advanced investigations are not available for definitive diagnosis. However, in a well-equipped setting, the diagnosis can be adequately established by excluding other causes and isolating a characteristic pathogen [9]. This involves the use of noninvasive and invasive measures including laparoscopy and laparotomy. Perihepatitis can be definitively distinguished from other causes of right upper quadrant pain only by directly visualizing the liver by laparoscopy or laparotomy [10]. Despite the recent advances in imaging techniques like Computer tomography (CT) scans involved in diagnosing FHCS © The Author(s) 2017. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/ publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. [11], with a high sensitivity of 88% and specificity of 95%, we face difficulties in poor countries with limited access to this advanced technology. Ultrasound findings are usually non-specific: perihepatic and pericholecystic effusions and adhesions between the liver and anterior abdominal wall [12–14]; and are sometimes normal in several patients [5]. Ultrasonography therefore plays a vital role in excluding other diagnosis rather than confirmation of FHCS [10]. Ligase chain reaction (LCR) and nucleic acid amplification (NAA) tests are the most sensitive and specific tests in the diagnoses of C. trachomatis [10]. However, serological tests are also very helpful, especially because of their cost-effectiveness [15]. Nonspecific investigations like liver enzymes and white blood cell counts (WBC) used to exclude differentials of RUQ pain are usually within normal ranges or mildly increased in FHCS [9]. Treatment consists of antibiotics directed against N. gonorrhoeae and C. trachomatis; mechanical lyses of adhesions can be performed s (...truncated)


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Cyril Jabea Ekabe, Jules Kehbila, Tsi Njim, Benjamin Momo Kadia, Celestine Ntemlefack Tendonge, Gottlieb Lobe Monekosso. Chlamydia trachomatis-induced Fitz-Hugh–Curtis syndrome: a case report, BMC Research Notes, 2017, pp. 10, Volume 10, Issue 1, DOI: 10.1186/s13104-016-2357-z