A Sexually Active 30-Year-Old Woman With Rash and Wrist Pain

Discussion

Fitz-Hugh-Curtis syndrome is a rare manifestation of chronic pelvic inflammatory disease (PID) in young women of childbearing age. The syndrome may mimic numerous other diseases, including:

• Viral hepatitis

• Acute cholecystitis

• Subphrenic or hepatic abscess

• Ectopic pregnancy

• Right-sided renal colic or pyelonephritis

• Pleurisy

• Herpes zoster

• Appendicitis with an atypical presentation

The findings in this patient were specific for Fitz-Hugh-Curtis syndrome. The other options in the differential diagnosis could be excluded on the basis of the clinical presentation and the laboratory results.

This patient has risk factors for the acquisition of viral hepatitis (sex with multiple partners, inconsistent use of contraceptives), and she presents with right upper quadrant pain. However, she does not have jaundice or an acute elevation in aminotransferase levels. In addition, the results of her hepatitis serology tests are negative. Ultrasound and CT imaging do not reveal any hepatic inflammation. These findings make acute viral hepatitis highly unlikely.

Right upper quadrant pain in a woman of childbearing age could be due to acute cholecystitis. The normal liver function results, including alkaline phosphatase, and the absence of evidence of cholelithiasis or cholecystitis on the patient's right upper quadrant ultrasound rule out this possibility.

Amebic liver abscess can present with a similar clinical scenario; however, the complete blood cell count did not reveal any elevation in eosinophils. Moreover, the hepatic ultrasound and the abdominal CT did not show any fluid collection indicating a hepatic abscess. On the basis of CT findings, gastrointestinal surgery was consulted. Laparoscopy was performed and dense violin string adhesions between the liver and the diaphragm anterior abdominal wall were identified. Figure 2 shows perihepatic adhesions in a different patient. No peritoneal seeding was noted. A KTP/532 laser was introduced through a secondary site, and the adhesions were carefully removed.

(Enlarge Image)

Figure 2.

Fitz-Hugh-Curtis syndrome is also known as perihepatitis. It causes inflammation of the liver capsule with adhesion formation, resulting in right upper quadrant pain that often radiates to the shoulder. The parenchyma of the liver remains unaffected. Laparoscopy or laparotomy reveals adhesions in the hepatic capsule, which can be confirmed on biopsy and culture. Although far more common in females, Fitz-Hugh-Curtis syndrome can occur in both sexes. Multiple case reports describe atypical presentations.^[1,2,3]

The syndrome is usually a complication of chronic PID that results from various sexually transmitted infections (STIs), including gonococcal and chlamydial infections. The infection may start as a vaginitis or cervicitis that leads to subsequent ascending infection, which may cause endometritis, salpingitis, tubo-ovarian abscess, pelvic peritonitis, or Fitz-Hugh-Curtis syndrome. In addition, intrauterine devices (IUDs) may be colonized and cause recurrent infections as well as distant spread via the lymphatics or hematogenous seeding.^[4,5,6]

Medscape © 2022 WebMD, LLC

Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: Amber M. Bokhari. A Sexually Active 30-Year-Old Woman With Rash and Wrist Pain - Medscape - Jan 11, 2022.