Fitz-Hugh-Curtis syndrome: what is it, causes, symptoms, treatment

general information

Fitz-Hugh-Curtis Syndrome Is a rare disease that occurs almost exclusively in women. It is characterized by inflammation of the membranes lining the stomach (peritoneum) and the tissues surrounding the liver (perihepatitis). The muscle that separates the stomach and chest (diaphragm), which plays an important role in breathing, can also be affected. Common symptoms include severe pain in the upper right abdomen (quadrant) of the abdomen, fever, chills, headaches, and a general feeling of being unwell (malaise).

Fitz-Hugh-Curtis syndrome is a complication of pelvic inflammatory disease (PID), a generic term for an upper genital tract infection in women. The infection is most commonly caused by Neisseria gonorrhoeae (gonococcus) and Chlamydia trachomatis (a type of chlamydia).

Signs and symptoms

Fitz-Hugh-Curtis syndrome is characterized by sudden, severe pain in the upper right abdomen. The pain can spread to additional areas, including the right shoulder and the inside of the right arm. Movement often makes the pain worse. The top right area can be very sensitive.

In some cases, additional symptoms may occur, including

• heat;
• chills;
• night sweats;
• vomiting;
• nausea.

Some people affected may develop headaches, hiccups, and a general feeling of ill health (malaise).

Some people may have symptoms associated with inflammatory diseases of the pelvic organsincluding fever vaginal discharge and pain in the lower abdomen. Lower abdominal pain may precede, follow, or occur concurrently with upper abdominal pain.

Causes and risk factors

In most cases, Fitz-Hugh-Curtis syndrome is caused by infection with the bacterium Chlamydia trachomatis, which causes chlamydia or Neisseria gonorrhoeae, causing gonorrhea. Chlamydia and gonorrhea are common sexually transmitted diseases (STDs). Researchers believe that more cases of Fitz-Hugh-Curtis syndrome are caused by Chlamydia trachomatis infection than Neisseria gonorrhoeae.

The exact process by which such infections cause Fitz-Hugh-Curtis syndrome (pathogenesis) is not fully understood. Some researchers believe that this is due to infection liver and surrounding tissues as a result of bacteria moving from the pelvis directly to the liver or through the bloodstream or lymphatic system.

Some researchers have suggested that Fitz-Hugh-Curtis syndrome may occur due to improper immune response (autoimmunity) to Neisseria gonorrhoeae or Chlamydia infection trachomatis. Autoimmune Disorders occur when the body's natural defenses (antibodies, lymphocytes, etc.) against invading organisms suddenly start attacking perfectly healthy tissues. Several studies have shown that people with Fitz-Hugh-Curtis syndrome have high levels of antibodies against Chlamydia trachomatis. More research is needed to determine the role of autoimmunity in the development of Fitz-Hugh-Curtis syndrome.

Fitz-Hugh-Curtis syndrome is characterized by a developed filamentous fibrous scar tissue (spaks) between the liver and the abdominal wall or diaphragm.

Affected populations

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. This occurs more frequently in adolescents with PID, as adolescents 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.

Symptomatic disorders

Symptoms of the following disorders may be similar to those of Fitz-Hugh-Curtis syndrome. Comparisons can be useful for differential diagnosis.

• Viral hepatitis Is an inflammation of the liver caused by a virus infection. There are five types of viral hepatitis called A, B, C, D, and E. Hepatitis AA, B and C are the most common. Some people may not develop obvious symptoms. Symptoms that may occur include nausea, vomiting, headaches, muscle pain, abdominal pain, and yellowing of the whites of the eyes and mucous membranes (jaundice).
• Cholecystitis Is inflammation gallbladder, a pear-shaped muscle sac that lies under the liver. The main function of the gallbladder is to store and concentrate bile and excrete it through the bile duct during the digestion of fats. (Bile is a greenish-brown liquid produced by the liver that breaks down fats present in the small intestine during digestion.) Cholecystitis can occur suddenly (acute) or persist for a period of time (chronic). Acute cholecystitis Usually caused by a blockage in the gallbladder outlet, often caused by a stone in the biliary tract (gallstone or biliary mass). Repeated mild episodes of acute cholecystitis can lead to chronic cholecystitis, which can be characterized by thickening and contraction of the walls of the gallbladder and, as a result, an inability to store bile. Cholecystitis can cause a variety of symptoms, including severe pain in the right abdomen (upper right quadrant) and / or back, nausea, vomiting, indigestion, fever, and persistent yellowing of the skin, mucous membranes, and whites of the eyes (jaundice). In some cases, there may be additional symptoms.

Many additional conditions can mimic Fitz-Hugh-Curtis syndrome, including:

• gallstone disease;
• pyelonephritis;
• pancreatitis;
• shingles;
• appendicitis;
• nephrolithiasis;
• peptic ulcer;
• bacterial, fungal or viral pneumonia.

Diagnostics

The diagnosis of Fitz-Hugh-Curtis syndrome is made by ruling out other causes of pain in the upper right abdomen. The diagnosis can be confirmed by various special tests, including x-rays, diagnostic laparoscopy, and some laboratory tests. X-rays may include ultrasound, chest or stomach x-rays, and computed tomography (CT) scans. X-rays are used to rule out other possible conditions (described above) or to detect characteristic inflammation of the perihepatic region. During laparoscopy, a small abdominal tube is inserted into the abdomen through a small incision in the stomach. A laparoscopic examination allows the doctor to examine the liver and surrounding tissue. Laboratory tests (urine, blood) can detect infection with Chlamydia trachomatis or Neisseria gonorrhoeae.

Standard treatments

Treatment for Fitz-Hugh-Curtis syndrome targets the specific symptoms that each person experiences. Antibiotic therapy is the main therapy for people with Fitz-Hugh-Curtis syndrome. Different regimens for tetracycline, doxycycline, ofloxacin, metronidazole, and additional antibiotics may be prescribed to combat the underlying infection. In some cases, pain relievers (analgesics) such as acetaminophen and codeine may be used.

In some cases, antibiotic therapy may not relieve symptoms, so a surgical procedure known as a laparotomy may be performed. During a laparotomy, a small, thin instrument is inserted into the abdominal cavity through a small incision made in the abdominal cavity. Doctors can then destroy any fibrous scar tissue (adhesions) found in the perihepatic region.

Forecast

The prognosis is usually the same as for PID.