A rare case of Fitz-Hugh–Curtis syndrome caused by Chlamydia trachomatis in an HIV-positive male patient

• Published in: SAGE open medical case reports Vol. 7; p. 2050313X18823592
• Main Authors: Lisičar, Iva, Begovac, Josip, Zekan, Šime
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.01.2019; Sage Publications Ltd
• Subjects: Abdomen; Case Report; Case reports; Chlamydia; HIV; Human immunodeficiency virus; Liver; Pain; Ultrasonic imaging; Chlamydia trachomatis; Infectious diseases; Fitz-Hugh–Curtis syndrome; HIV; pelvic inflammatory disease; men who have sex with men
• ISSN: 2050-313X; 2050-313X
• DOI: 10.1177/2050313X18823592

Fitz-Hugh–Curtis syndrome, a rare complication of pelvic inflammatory disease, is an inflammation of the liver capsule (thus called perihepatitis) and the surrounding peritoneum. It occurs extremely rarely in men and is typically characterized by a sudden onset of severe pain in the right upper abdominal quadrant. Ultrasound examination of the liver does not reveal any morphologic changes, and liver function tests are usually normal. Computerized tomography shows the thickening of the perihepatic fat, but definitive diagnosis is only possible by direct visualization by laparoscopy or laparotomy. We present a 33-year-old HIV-positive man with Chlamydia trachomatis proctitis who developed severe right upper abdominal quadrant pain. Abdominal ultrasound did not show any liver pathology, while computerized tomography revealed hepatic capsular thickening. After 21 days of doxycycline therapy, the patient’s symptoms subsided. Based on the clinical presentation and liver computerized tomography examination, the diagnosis of proctitis and the resulting Fitz-Hugh–Curtis syndrome was made. Although it is rarely seen in male patients, it should be a part of differential diagnosis in patients who present with right upper abdominal quadrant pain, especially in men who have sex with other men.