A case of Fitz-Hugh-Curtis syndrome diagnosed by noninvasive metagenomic next-generation sequencing

• Published in: Taiwanese journal of obstetrics & gynecology Vol. 63; no. 6; pp. 935 - 940
• Main Authors: Ding, Chengcheng, Chen, Run, Guo, Peng, Yang, Juhua, He, Mian
• Format: Journal Article
• Language: English
• Published: China (Republic : 1949- ) Elsevier B.V 01.11.2024; Elsevier
• Subjects: Anti-Bacterial Agents - therapeutic use; Ascitic Fluid - microbiology; Chlamydia Infections - diagnosis; Chlamydia Infections - microbiology; Chlamydia trachomatis; Chlamydia trachomatis - genetics; Chlamydia trachomatis - isolation & purification; Early diagnosis; Female; Hepatitis - diagnosis; Hepatitis - microbiology; High-Throughput Nucleotide Sequencing - methods; Humans; Internal Medicine; Metagenomics - methods; Obstetrics and Gynecology; Pelvic inflammatory disease; Pelvic Inflammatory Disease - diagnosis; Pelvic Inflammatory Disease - microbiology; Peritonitis - diagnosis; Peritonitis - drug therapy; Peritonitis - microbiology; Sexually transmitted diseases; Young Adult; Sexually transmitted diseases; Early diagnosis; Chlamydia trachomatis; Pelvic inflammatory disease
• ISSN: 1028-4559; 1875-6263
• DOI: 10.1016/j.tjog.2024.04.020

Fitz-Hugh-Curtis Syndrome (FHCS) is an inflammation of the liver capsule as a complication of pelvic inflammatory disease (PID) in sexually active women, mostly associated with Chlamydia trachomatis (C. trachomatis) and Neisseria gonorrhoeae. Classically presenting as sharp right upper quadrant pain, usually accompanied salpingitis and ascites. With nonspecific clinical presentation and poor specificity, definitive diagnosis needs tissue biopsy and culture by laparoscopy. We report the case of a 22-year-old female with a 2-month history of abdominal pain and distention. Symptomatic relief when supportive treatments were given, with the ultrasound and PET-CT suggested advanced bilateral ovarian cancer. After metagenomic next-generation sequencing (mNGS) detected C. trachomatis in ascitic fluid. Following anti-infective medication, clinical improvement was satisfactory and the patient was discharged. FHCS with distention was rare and challenging to diagnose. The mNGS would be a potent, non-invasive pathogen detection method with significant sensitivity and specificity.