Fitz-Hugh-Curtis syndrome is a rare disorder that occurs almost exclusively in women. It is characterized by inflammation of the membrane lining the stomach (peritoneum) and the tissues surrounding the liver (perihepatitis). The muscle that separates the stomach and the chest (diaphragm), which plays an essential role in breathing, may also be affected. Common symptoms include severe pain in the upper right area (quadrant) of the abdomen, fever, chills, headaches, and a general feeling of poor health (malaise). Fitz-Hugh-Curtis syndrome is a complication of pelvic inflammatory disease (PID), a general term for infection of the upper genital tract in women. Infection is most often caused by Neisseria gonorrhoeae and Chlamydia trachomatis.
Fitz-Hugh-Curtis syndrome is characterized by the onset of sudden, severe pain in the upper right area of the abdomen. Pain may spread to additional areas including the right shoulder and the inside of the right arm. Movement often increases pain. The upper right area may be extremely tender.
Additional symptoms may occur in some cases including fever, chills, night sweats, vomiting and nausea. Some affected individuals may develop headaches, hiccupping, and a general feeling of poor health (malaise).
Some affected individuals may have symptoms associated with pelvic inflammatory disease including fever, vaginal discharge, and lower abdominal pain. Lower abdominal pain may precede, follow, or occur simultaneously with upper abdominal pain.
Most cases of Fitz-Hugh-Curtis syndrome are caused by infection with the bacterium Chlamydia trachomatis, which causes Chlamydia or the organism Neisseria gonorrhoeae, which causes gonorrhea. Chlamydia and gonorrhea are common sexually transmitted diseases (STDs). Researchers believe that more cases of Fitz-Hugh-Curtis syndrome are caused by infection with Chlamydia trachomatis than with Neisseria gonorrhoeae.
The exact process by which such infections cause Fitz-Hugh-Curtis syndrome (pathogenesis) is not completely understood. Some researchers believe that it occurs because of infection of the liver and surrounding tissue, which may result from bacteria traveling from the pelvis directly to the liver or via the bloodstream or lymphatic system.
Some researchers have speculated that Fitz-Hugh-Curtis syndrome may occur because of an improper immune system response (autoimmunity) to infection with Neisseria gonorrhoeae or Chlamydia trachomatis. Autoimmune disorders are caused when the body’s natural defenses (antibodies, lymphocytes, etc), against invading organisms suddenly begin to attack perfectly healthy tissue. Several studies have demonstrated that individuals with Fitz-Hugh-Curtis syndrome have high levels of antibodies against Chlamydia trachomatis. More research is necessary to determine what role autoimmunity plays in the development of Fitz-Hugh-Curtis syndrome.
Fitz-Hugh-Curtis syndrome is characterized by the developed of string-like, fibrous scar tissue (adhesions) between the liver and the abdominal wall or the diaphragm.
The vast majority of cases occur in women of reproductive age who have pelvic inflammatory disease (PID). Approximately 4-14 percent of women with PID develop Fitz-Hugh-Curtis syndrome. It occurs with greater frequency in adolescents with PID because they are more susceptible to infection.
The actual incidence of Fitz-Hugh-Curtis syndrome in the general population is unknown. In extremely rare cases, it has occurred in men. Fitz-Hugh-Curtis syndrome was first described in the medical literature in 1920.
A diagnosis of Fitz-Hugh-Curtis syndrome is made through the exclusion of other causes of upper right abdominal pain. A diagnosis may be confirmed with a variety of specialized tests including x-ray examination, diagnostic laparoscopy, and certain laboratory exams. X-ray examination may include ultrasound, chest or stomach radiographs, and computed tomography (CT) scanning. X-rays are used to rule out other possible conditions or reveal characteristic inflammation of the perihepatic region. During a laparoscopy, a small, thing tube is inserted in the abdominal cavity through a small incision in the stomach. A laparoscopic exam allows a physician to view the liver and surrounding tissue. Laboratory exams can identify infection with Chlamydia trachomatis or Neisseria gonorrhoeae.
The treatment of Fitz-Hugh-Curtis syndrome is directed toward the specific symptoms that are apparent in each individual. Antibiotic therapy is the mainstay treatment for individuals with Fitz-Hugh-Curtis syndrome. Different regimens of tetracycline, doxycycline, ofloxacin, metronidazole, and additional antibiotics may be prescribed to fight the underlying infection. Pain medications (analgesics) such as acetaminophen and codeine may be used in some cases. The Centers for Disease Control and Prevention (CDC) has released guidelines on the treatment of pelvic inflammatory disease.
In some cases, antibiotic therapy may not provide relief of symptoms and a surgical procedure known as a laparotomy may be performed. During a laparotomy, a small, thin instrument is inserted in the abdominal cavity through a small incision made in the abdomen. Physicians can then destroy any fibrous scar tissue (adhesions) found in the perihepatic region.
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Frumovitz MM. Fitz-Hugh-Curtis syndrome. Emedicine Journal, August 28, 2006. Available at: http://www.emedicine.com/med/topic797.htm Accessed on: October 12, 2006.