Fitz-Hugh-Curtis syndrome (FHCS) is a rare complication of pelvic inflammatory disease (PID). FHCS occurs almost exclusively in females and can cause abdominal pain, fever, and malaise.

Other names for FHCS may include gonococcal perihepatitis and perihepatitis syndrome. The condition occurs as a potential complication of PID, when a person experiences inflammation of the tissues surrounding the liver. Doctors call this condition perihepatitis, which often results in severe pain in the upper right area of the abdomen.

In this article, we will discuss FHCS, including the symptoms, treatments, causes, and risk factors for the condition.

A note about sex and gender

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

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PID typically occurs due to an infection that affects the female reproductive system. It often begins in the vagina and then spreads to the cervix, fallopian tubes, and ovaries. In 85% of PID cases, sexually transmitted infections (STIs) cause the condition. The most common causes of a PID infection include chlamydia and gonorrhea.

FHCS describes an uncommon complication of PID. It occurs when inflammation from PID spreads to the membrane lining of the stomach and tissues surrounding the liver. In some cases, it may also affect the diaphragm.

FHCS occurs almost exclusively in females and most often affects sexually active females between 15 and 30 years of age. Though there are around 750,000 cases of PID in the United States annually, FHCS is rare and affects around 4% of adolescents.

There are a few factors that can increase a person’s risk of developing PID. These may include:

  • having an untreated STI
  • having more than one sexual partner
  • having a sexual partner who has other sexual partners
  • having had PID before
  • being sexually active and being 25 years old or younger
  • using a douche

Using an intrauterine device (IUD) for birth control can also cause a slight increased risk of PID. However, this risk is less likely to occur after the first 3 weeks after the doctor has placed the IUD inside the uterus.

FHCS commonly causes a person to experience right upper quadrant abdominal pain. This is due to the inflammation of the liver capsule and the adhesion of the space between the liver capsule and the parietal peritoneum. The parietal peritoneum refers to the layers of tissue that line the abdominal wall. A person’s right upper quadrant abdominal pain usually becomes worse with movement and breathing.

Other possible symptoms of FHCS may include:

FHCS may have similar symptoms to several other conditions. As such, a doctor may carry out a differential diagnosis to rule out the following conditions when making a diagnosis:

During a diagnosis, a doctor may carry out one of the following lab tests:

  • Pregnancy test: A doctor may carry out a pregnancy test to guide their choice of antibiotic therapy and help address whether the person has an ectopic pregnancy.
  • Complete blood count (CBC): A doctor may use a CBC to look for a high white blood cell count. Around 50% of people with PID have a significantly raised white blood cell count.
  • Comprehensive metabolic panel: This test can help a doctor assess a person’s electrolyte levels as well as any atypical liver or kidney readings.
  • Sexually transmitted infection test: This can test for chlamydia and gonorrhea, which can indicate that a person may have FHCS.

A doctor may also carry out a CT scan. This scan uses detail from several X-rays to create detailed images of structures inside the body. A doctor may use a CT scan to look for increased blood flow in the liver capsule due to the inflammation. This can help a doctor make an early diagnosis of FHCS.

A doctor may also use a laparoscopy to help make a diagnosis. During this procedure, a doctor inserts a laparoscope through a small incision. The laparoscope has a small light and a camera on the end, which allows healthcare professionals to see inside the body. A doctor can use a laparoscopy to look for adhesion between the diaphragm and liver or the liver and the anterior abdominal wall, which are often present in people with FHCS.

A doctor will often treat a person’s PID alongside their FHCS. The main aims of treatment include:

  • relieving symptoms
  • eradicating the infection
  • minimizing the risks of long-term complications, such as infertility or ectopic pregnancy

A doctor will most often use antibiotics to treat the infection. This treatment is typically effective, and most people with PID can receive treatment as outpatients.

A doctor may wish to treat a person in a hospital if they:

  • have an uncertain diagnosis
  • are pregnant
  • are displaying signs of a severe illness
  • have pelvic abscesses
  • are unable to tolerate taking medications orally
  • have an immunodeficiency
  • show no signs of improvement after 72 hours of treatment

FHCS usually responds very well to antibiotic treatment. This treatment often leads to a full recovery and prevents a person from developing long-term complications.

FHCS is a potential and uncommon complication of PID that occurs almost exclusively in females. It occurs when a PID spreads to the liver, causing inflammation in the tissues surrounding the liver. This often causes uncomfortable symptoms, such as severe pain in the right upper abdominal quadrant.

A doctor may carry out blood tests and imaging tests to help diagnose FHCS. Typically, a healthcare professional can use a laparoscopy to confirm the diagnosis. Treatment for FHCS often involves antibiotics, which aim to relieve symptoms and eradicate the infection causing the PID. FHCS usually responds well to antibiotics, often leading to a full recovery and no long-term complications.