A 26-year-old sexually active woman presented with a 3-day history of persistent right upper quadrant pain. She had no fever or digestive symptoms. A physical examination revealed right upper quadrant tenderness, and Murphy's sign was positive. The pain was exacerbated by deep breathing, lying in the supine position, and lying in the right lateral position, thus suggesting Fitz-Hugh-Curtis syndrome (1,2). Abdominal contrast-enhanced computed tomography (arterial phase) images, with the patient lying on her left side because pain prevented her from lying in the supine position, showed faint enhancement of the hepatic margin (Picture), confirming the diagnosis of Fitz-Hugh-Curtis syndrome. A cervical swab tested positive for Chlamydia trachomatis on polymerase chain reaction. She was treated with doxycycline 100 mg twice daily for seven days.
Picture.
Fitz-Hugh-Curtis syndrome is perihepatic inflammation associated with pelvic inflammatory disease (1). Right upper quadrant pain may be the only symptom (1). Murphy's sign is positive in 20% of cases (2).
The patient has provided written consent for publication of the image and the accompanying description.
The authors state that they have no Conflict of Interest (COI).
References
- 1.Khine H, Wren SB, Silver EJ, Tun J, Goldman DL. Fitz-Hugh-Curtis syndrome in adolescent and young adult females: utility of a decision rule. Am J Emerg Med 50: 183-186, 2021. [DOI] [PubMed] [Google Scholar]
- 2.Counselman FL. An unusual presentation of Fitz-Hugh-Curtis syndrome. J Emerg Med 12: 167-170, 1994. [DOI] [PubMed] [Google Scholar]