A rare case of Fitz-Hugh–Curtis syndrome caused by Chlamydia trachomatis in an HIV-positive male patient

Abstract

Fitz-Hugh–Curtis syndrome, a rare complication of pelvic inflammatory disease, is an inflammation of the liver capsule (thus called perihepatitis) and the surrounding peritoneum. It occurs extremely rarely in men and is typically characterized by a sudden onset of severe pain in the right upper abdominal quadrant. Ultrasound examination of the liver does not reveal any morphologic changes, and liver function tests are usually normal. Computerized tomography shows the thickening of the perihepatic fat, but definitive diagnosis is only possible by direct visualization by laparoscopy or laparotomy. We present a 33-year-old HIV-positive man with Chlamydia trachomatis proctitis who developed severe right upper abdominal quadrant pain. Abdominal ultrasound did not show any liver pathology, while computerized tomography revealed hepatic capsular thickening. After 21 days of doxycycline therapy, the patient’s symptoms subsided. Based on the clinical presentation and liver computerized tomography examination, the diagnosis of proctitis and the resulting Fitz-Hugh–Curtis syndrome was made. Although it is rarely seen in male patients, it should be a part of differential diagnosis in patients who present with right upper abdominal quadrant pain, especially in men who have sex with other men.

Mpox proctitis as a likely predisposing factor for chlamydial perihepatitis in a male patient

“…Perihepatitis was believed to affect only women. However, 12 cases in men have been reported, of which C. trachomatis was confirmed in 2 2 4–10. The exact pathogenesis is not fully understood.…”

Perihepatitis (Fitz-Hugh-Curtis syndrome): Case report and review of literature

“…Curtis first reported this syndrome in 1930 in a female patient who suffered from gonococcal salpingitis. In 1934, Fitz-Hugh reported three female patients who had severe RUQ pain and suffered from gonococcal salpingitis [2]. Fitz-Hugh-Curtis's syndrome is classically occurring in reproductive-aged women with sexual activity; it is seldom reported in men, most likely because men are rarely affected by pelvic inflammatory disease.…”

“…Fitz-Hugh-Curtis's syndrome is classically occurring in reproductive-aged women with sexual activity; it is seldom reported in men, most likely because men are rarely affected by pelvic inflammatory disease. Men are usually mentioned only as transmitters of the pathogen [2,3]. Most cases of FHCS are caused by infection with the bacterium Chlamydia trachomatis and Neisseria gonorrhoeae.…”

Hiccups Caused by Fitz-Hugh-Curtis Syndrome

“…Moreover, systemic lupus erythematosus, which is occasionally associated with hepatic capsule enhancement, is an important differential diagnosis of perihepatitis in young female patients (such as in this case) 4 , because most FHCS and systemic lupus erythematosus cases occur more frequently in women than in men. 5 FHCS is also often associated with upper abdominal pain and right lower quadrant pain; thus, it should be also differentiated from appendicitis. However, appendicitis could complicate this condition.…”