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Fitz Hugh Curtis Syndrome

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Copyright 1993, 1999, 2006, 2009

Synonyms of Fitz Hugh Curtis Syndrome

Disorder Subdivisions

General Discussion

Fitz-Hugh-Curtis syndrome is a rare disorder that occurs almost exclusively in women. It is characterized by inflammation of the membrane lining the stomach (peritoneum) and the tissues surrounding the liver (perihepatitis). The muscle that separates the stomach and the chest (diaphragm), which plays an essential role in breathing, may also be affected. Common symptoms include severe pain in the upper right area (quadrant) of the abdomen, fever, chills, headaches, and a general feeling of poor health (malaise). Fitz-Hugh-Curtis syndrome is a complication of pelvic inflammatory disease (PID), a general term for infection of the upper genital tract in women. Infection is most often caused by Neisseria gonorrhoeae and Chlamydia trachomatis.

Symptoms

Fitz-Hugh-Curtis syndrome is characterized by the onset of sudden, severe pain in the upper right area of the abdomen. Pain may spread to additional areas including the right shoulder and the inside of the right arm. Movement often increases pain. The upper right area may be extremely tender.

Additional symptoms may occur in some cases including fever, chills, night sweats, vomiting and nausea. Some affected individuals may develop headaches, hiccupping, and a general feeling of poor health (malaise).

Some affected individuals may have symptoms associated with pelvic inflammatory disease including fever, vaginal discharge, and lower abdominal pain. Lower abdominal pain may precede, follow, or occur simultaneously with upper abdominal pain.

Causes

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

The exact process by which such infections cause Fitz-Hugh-Curtis syndrome (pathogenesis) is not completely understood. Some researchers believe that it occurs because of infection of the liver and surrounding tissue, which may result from bacteria traveling from the pelvis directly to the liver or via the bloodstream or lymphatic system.

Some researchers have speculated that Fitz-Hugh-Curtis syndrome may occur because of an improper immune system response (autoimmunity) to infection with Neisseria gonorrhoeae or Chlamydia trachomatis. Autoimmune disorders are caused when the body's natural defenses (antibodies, lymphocytes, etc), against invading organisms suddenly begin to attack perfectly healthy tissue. Several studies have demonstrated that individuals with Fitz-Hugh-Curtis syndrome have high levels of antibodies against Chlamydia trachomatis. More research is necessary to determine what role autoimmunity plays in the development of Fitz-Hugh-Curtis syndrome.

Fitz-Hugh-Curtis syndrome is characterized by the developed of string-like, fibrous scar tissue (adhesions) between the liver and the abdominal wall or the 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. It occurs with greater frequency in adolescents with PID because they 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.

Related Disorders

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

Viral hepatitis is inflammation of the liver caused by infection with a virus. There are five types of viral hepatitis named A, B, C, D, and E. Hepatitis types A, B and C are the most common. Some individuals may not develop apparent symptoms (asymptomatic). Symptoms that can occur include nausea, vomiting, headaches, muscle aches, pain in the abdomen, and yellowing of the whites of the eyes and the mucous membranes (jaundice). (For more information on this disorder, choose "hepatiti" as your search term in the Rare Disease Database.)

(For more information on this disorder, choose "cholecystiti" as your search term in the Rare Disease Database.)

A variety of additional conditions may resemble Fitz-Hugh-Curtis syndrome including cholelithiasis, pyelonephritis, pancreatitis, herpes zoster, appendicitis, nephrolithiasis, peptic ulcer disease, and bacterial, fungal or viral pneumonia. (For more information on these conditions, choose the specific name as your search term in the Rare Disease Database

Cholecystitis is inflammation of the gallbladder, the pear-shaped muscular sac that lies below the liver. The gallbladder's main function is to store and concentrate bile and to expel the bile 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 may come on suddenly (acute) or may persist over a period of time (chronic). Acute cholecystitis is usually caused by obstruction of the outlet of the gallbladder, which is often due to the development of a stone formed in the biliary tract (gallstone or biliary calculus). Repeated mild episodes of acute cholecystitis may result in chronic cholecystitis, which may be characterized by thickening and shrinking of the gallbladder walls and a resulting inability to store bile. Cholecystitis may cause a variety of symptoms including severe pain in the right side of the abdomen (right upper 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.

Standard Therapies

Diagnosis
A diagnosis of Fitz-Hugh-Curtis syndrome is made through the exclusion of other causes of upper right abdominal pain. A diagnosis may be confirmed with a variety of specialized tests including x-ray examination, diagnostic laparoscopy, and certain laboratory exams. X-ray examination may include ultrasound, chest or stomach radiographs, and computed tomography (CT) scanning. X-rays are used to rule out other possible conditions or reveal characteristic inflammation of the perihepatic region. During a laparoscopy, a small, thing tube is inserted in the abdominal cavity through a small incision in the stomach. A laparoscopic exam allows a physician to view the liver and surrounding tissue. Laboratory exams can identify infection with Chlamydia trachomatis or Neisseria gonorrhoeae.

Treatment
The treatment of Fitz-Hugh-Curtis syndrome is directed toward the specific symptoms that are apparent in each individual. Antibiotic therapy is the mainstay treatment for individuals with Fitz-Hugh-Curtis syndrome. Different regimens of tetracycline, doxycycline, ofloxacin, metronidazole, and additional antibiotics may be prescribed to fight the underlying infection. Pain medications (analgesics) such as acetaminophen and codeine may be used in some cases. The Centers for Disease Control and Prevention (CDC) has released guidelines on the treatment of pelvic inflammatory disease.

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

Investigational Therapies

Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site.

For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:

Tollfree: (800) 411-1222
TTY: (866) 411-1010
Email: prpl@cc.nih.gov

For information about clinical trials sponsored by private sources, contact:
www.centerwatch.com

Organizations related to Fitz Hugh Curtis Syndrome

References

JOURNAL ARTICLES
Piscaglia F, Vidili G, Ugolini G, et al., Fitz-Hugh-Curtis syndrome mimicking acute cholecystitis: value of new ultrasound findings in the differential diagnosis. Ultraschall Med. 2005;26:227-30.

Peter NG, Clark LR, Jaeger JR. Fitz-Hugh-Curtis syndrome: a diagnosis to consider in women with right upper quadrant pain. Cleve Clin J Med. 2004;71:233-9.

Banikarim C, Chacko MR. Pelvic inflammatory disease in adolescents. Adolesc Med Clin. 2004;2:173-85.

Pickhardt PJ, Fleishman MJ, Fisher AJ. Fitz-Hugh-Curtis syndrome: multidetector CT findings of transient hepatic attenuation difference and gallbladder wall thickening. AJR. 2003;180:1605-6.

Kaan JA, Branger J, van Ampting JM, Speelman P. Fitz-Hugh-Curtis syndrome: 2 patients with perihepatitis and sepsis. Ned Tijdschr Geneeskd. 2002;146:954-7.

Wu HM, Lee CL, Yen CF, Wang CJ, Soong YK. Laparoscopic diagnosis and management of Fitz-Hugh-Curtis syndrome: report of three cases. Chang Gung Med J. 2001;24:388-92.

Durastante V, Conte L, Cinque A, et al., Venereal perihepatitis: Fitz-Hugh-Curtis syndrome. Minerva Chir. 1995;50:793-8.

Owens S, Yeko TR, Bloy R, Maroulis GB. Laparascopic treatment of painful perihepatic adhesions in Fitz-Hugh-Curtis syndrome. Obstet Gynecol. 1991;78:542-3.

Katzman DK, Friedman IM, McDonald CA, Litt IF. Chlamydia trachomatis Fitz-Hugh-Curtis syndrome without salpingitis in female adolescents. Am J Dis Child. 1988;142:996-8.

FROM THE INTERNET
Frumovitz MM. Fitz-Hugh-Curtis syndrome. Emedicine Journal, August 28, 2006. Available at: http://www.emedicine.com/med/topic797.htm Accessed on: October 12, 2006.

Report last updated: 2009/05/12 00:00:00 GMT+0