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
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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
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[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)