Fitz-Hugh-Curtis Syndrome - Causes, Symptoms, and Treatment

Introduction:

Fitz-Hugh-Curtis syndrome is characterized by the inflammation of the hepatic (liver) capsule. Stajano first identified the syndrome. After ten years, Curtis discovered the adhesion between the anterior surface of the liver and the abdominal wall. After four years, Fitz-Hugh identified similar cases reporting the same symptoms and pain in the right upper part of the abdomen. The rare disorder is named after these two physicians.

What Are the Causes of Fitz-Hugh-Curtis Syndrome?

The causes of Fitz-Hugh-Curtis syndrome are as follows:

• The major factor is a pelvic inflammatory disease (PID). In pelvic inflammatory disease (PID), there is infection and inflammation of the female reproductive organs, that is, fallopian tubes (two tubes that are situated on either side of the uterus), ovaries, uterus (womb), cervix, and vagina. This infection spreads to the liver and can cause liver capsule inflammation. The PID is caused due to sexually transmitted diseases by the bacteria Gonorrhea and Chlamydia.

• Neisseria gonorrhea and Chlamydia trichomatis bacteria cause this syndrome.

• Occasionally other bacteria like Bacteroides, Escherichia coli, and Streptococcus cause Fitz-Hugh-Curtis syndrome.

• Another study also reveals that it is an autoimmune disorder.

• The syndrome affects women around the reproductive age and those below eighteen years and sexually active.

What Is the Pathophysiology of Fitz-Hugh-Curtis Syndrome?

The bacteria causes the cervical mucus to become thin so that it can freely move from the vagina to the uterus (womb) and fallopian tubes (two tubes on either side of the uterus) and cause infection and inflammation (swelling).

What Are the Symptoms of Fitz-Hugh-Curtis Syndrome?

The symptoms of Fitz-Hugh-Curtis syndrome are as follows:

• There is a triad of Fitz-Hugh-Curtis syndrome, which means inflammation of the liver capsule without the involvement of liver parenchyma, with adhesion formation associated with right upper side abdominal pain.

• There is sudden, severe pain in the upper right side of the abdomen just below the ribs. The pain is sudden.

• There is severe pain in the right shoulder and right arm.

• The pain intensity increases with the shoulder and arm movement, making it horrible.

• The right side chest pain sometimes.

• The other symptoms are:high-grade fever.

• Chills.

• Profuse sweating at night.

• Nausea.

• Vomiting.

• Severe headache.

• Uncontrolled hiccups.

• A feeling of not being well.

• Pelvic inflammatory disease (PID) symptoms include pain in the lower belly and vaginal secretions.

How Is Fitz-Hugh-Curtis Syndrome Diagnosed?

The laboratory tests conducted for correct diagnosis are as follows:

• A pregnancy test is essential, so the antibiotic prescribed is the low dosage and safer and accesses any ectopic pregnancy (the embryo develops outside the uterus).

• Complete blood count (CBC) to check for leucocytosis (increase in the number of white blood cells) and fifty percent of women with pelvic inflammatory disease (PID) have clinically significant leucocytosis.

• Blood cultures are generally negative in the case of PID.

• Access for electrolyte, hepatic or renal derangements.

• Access the vaginal secretions.

• Quantitative culture for Chlamydia and Gonorrhea.

• Rapid plasma reagin (RPR) is a diagnostic test for syphilis conducted and Hepatitis B and C tests, HIV tests, and urinalysis.

The radiological tests include the following:

• Computerized tomography (CT) scan assesses liver inflammation and checks for ovarian abscesses and fluid accumulation in the pelvic cavity.

• Ultrasonography scanning (ultraviolet rays are used to visualize the internal organs) is a diagnostic test.

• Magnetic resonance imaging (MRI) scan to check for abscess and swelling in the pelvic region.

• Laparoscopy procedure in which a tiny tube is inserted into the vagina and cervix and a small camera is attached to the tube so that the physician can visualize the internal organs and can access the swellings.

• An endometrial biopsy (a small tissue is excised for the examination).

What Is the Treatment For Fitz-Hugh-Curtis Syndrome?

The treatment for Fitz-Hugh-Curtis syndrome is based on the specific symptoms that develop in individuals.

• Antibiotic Therapy: Antibiotics like Tetracycline, Doxycycline, Ofloxacin, Metronidazole, and other antibiotics are prescribed in recommended doses to reduce the infection. Can prescribe painkillers to relieve pain, like Acetaminophen and Codeine.

• Laparotomy: When antibiotic therapy fails to decrease the symptoms, a laparotomy procedure is performed by physicians using a laparoscope inserted by placing a small insertion in the abdomen and destroying the fibrous scar tissue.

Hospital admission is recommended in cases such as uncertain diagnosis, pregnancy, severe complications, immunodeficiency, and those who do not recover with in seventy-two hours (three days) after antibiotic therapy.

How to Prevent Fitz-Hugh-Curtis Syndrome?

The best way to prevent Fitz-Hugh-Curtis syndrome is not to get infected with pelvic inflammatory disease (PID), the major causative factor.

• Avoid unprotected sex and recommend the use of condoms.

• Also, to limit the number of sexual partners.

• Recommended to test frequently for sexually transmitted infections if sexually active.

• Advised to get the sexual partners to get themselves tested for any infections.

• Inhibit douching (using chemical soaps to clean the vagina) as it makes them prone to various infections.

What Is the Differential Diagnosis of Fitz-Hugh-Curtis Syndrome?

The syndrome symptoms and signs are similar to other diseases like:

• Ectopic Pregnancy: The implantation of the fetus occurs on the outer side of the uterus(womb), that is, fallopian tubes, ovaries, and other regions. This is a severe complication.

• Cholecystitis: This means inflammation of the gall bladder. The bladder is present beneath the liver.

• Viral Hepatitis: Cause inflammation of the liver and damage. Occurs due to hepatitis viruses A, B, C, D, and E.

• Renal Colic: It causes sharp, intense pain due to kidney malfunction.

• Pyelonephritis: Inflammation of the kidney due to bacterial infection.

• Pulmonary Embolism: The lung arteries get blocked due to blood clots.

• Appendicitis: Inflammation of the appendix. This organ is non-functional in the body.

Conclusion:

Fitz-Hugh-Curtis syndrome is a rare disorder that affects the liver capsule, and the treatment is provided with great attention. Since the signs and symptoms of Fitz-Hugh-Curtis syndrome are similar to other infections, the diagnosis is crucial for proper management and to prevent complications. Once the symptoms are identified, there is a need to get themselves tested. Management of the syndrome should be early; if delayed, it can cause permanent damage and pelvic complications in the long run. The advent of minimally invasive procedures can decrease the risk of unnecessary surgeries if diagnosed early.