Don’t forget to consider Fitz-Hugh-Curtis Syndrome in your right upper quadrant pain differential!
Fits-Hugh-Curtis Syndrome is a rare disease process characterized by perihepatitis as a complication of pelvic inflammatory disease (PID). Patients usually present with severe and sudden onset pain in the right upper quadrant. Movement will typically worsen the pain. The patient may have fever, chills, night sweats, nausea, vomiting, headaches, and fatigue. Patients may also simultaneously have classic PID symptoms like vaginal discharge and lower abdominal pain.
The gold standard for diagnosis is laparoscopy. “Violin string”-like adhesions can be seen between the liver and the abdominal wall or diaphragm. Ultrasound of the abdomen may be normal. CT of the abdomen may show signs of perihepatitis. ESR has also been reported elevated in some cases. Treatment options include antibiotics to treat the causative bacteria, which are usually Chlamydia or Gonorrhea, and laparoscopy, which may be needed to break apart adhesions.
Curtis, Arthur H. “A cause of adhesions in the right upper quadrant.” Journal of the American Medical Association 94.16 (1930): 1221-1222.
“Fitz Hugh Curtis Syndrome.” NORD (National Organization for Rare Disorders). N.p., n.d. Web. 03 Feb. 2017. <https://rarediseases.org/rare-diseases/fitz-hugh-curtis-syndrome>.
Fitz-Hugh, Thomas. “Acute gonococcic peritonitis of the right upper quadrant in women.” Journal of the American Medical Association 102.25 (1934): 2094-2096.
Gupta, Nachi, and Jeff Nusbaum. “Ep 14: Otitis Media, Hemophilia, Pelvic Inflammatory Disease, Strep Pharyngitis, Frostbite…Balanitis, And More.” Audio blog post. Roshcast. N.p., 2 Feb. 2017. Web. 3 Feb. 2017. <https://www.roshreview.com/podcasts/ep-14-otitis-media-hemophilia-pelvic-inflammatory-disease-strep-pharyngitis-frostbite-balanitis>.
Woo, Seong Yong, et al. “Clinical outcome of Fitz-Hugh-Curtis syndrome mimicking acute biliary disease.” World J Gastroenterol 14.45 (2008): 6975-80.
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