title: Acute Fitz-Hugh-Curtis syndrome in a man due to gonococcal infection.
abstract: BACKGROUND
  Fitz-Hugh-Curtis syndrome is a rare extra-pelvic complication of genital infection involving the perihepatic capsule. Most cases have been described in women in association with pelvic inflammatory disease; in rare cases it has been reported in men. Because the main symptom is acute abdominal pain, and laboratory and imaging findings are frequently nonspecific, the differential diagnosis, considering other gastrointestinal or renal diseases, can be difficult in the early stage of the syndrome, leading to frequent misdiagnosis and mismanagement.
  
  
  METHODS
  We report a case of Fitz-Hugh-Curtis syndrome in a 26-year-old man who first presented to the emergency department with acute abdominal pain, vomiting, and fever. Diagnosis was possible on the basis of clinical signs of orchiepididymitis, abnormal ultrasound findings, and specialist consultation with the Sexually Transmitted Infection Clinic. An acute gonoccocal infection was revealed, which was complicated by a collection of free perihepatic fluid and a subcapsular hypoechoic focal lesion. Prompt antibiotic therapy was established, with complete resolution of the symptoms within a few days. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Awareness of the clinical presentation, imaging, and laboratory findings during the acute phase of Fitz-Hugh-Curtis syndrome could help emergency physicians to make an early diagnosis and to correctly manage such patients. Improved diagnostic skills could prevent chronic complications that are especially a risk in the case of delayed or minor genitourinary symptoms.
authors.affiliation: Microbiology Unit, Dipartimento di Medicina Specialistica Diagnostica e Sperimentale, University of Bologna, St Orsola Hospital, Bologna, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Nardini
authors.affiliation: Microbiology Unit, Dipartimento di Medicina Specialistica Diagnostica e Sperimentale, University of Bologna, St Orsola Hospital, Bologna, Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: Compri
authors.affiliation: Microbiology Unit, Dipartimento di Medicina Specialistica Diagnostica e Sperimentale, University of Bologna, St Orsola Hospital, Bologna, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Marangoni
authors.affiliation: Dermatology Unit, Dipartimento di Medicina Specialistica Diagnostica e Sperimentale, University of Bologna, St Orsola Hospital, Bologna, Italy.
authors.forename: Antonietta
authors.initials: A
authors.lastname: D'Antuono
authors.affiliation: Dermatology Unit, Dipartimento di Medicina Specialistica Diagnostica e Sperimentale, University of Bologna, St Orsola Hospital, Bologna, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Bellavista
authors.affiliation: Gastroenterology Unit, Dipartimento di Scienze Mediche e Chirurgiche, University of Bologna, St Orsola Hospital, Bologna, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Calvanese
authors.affiliation: Gastroenterology Unit, Dipartimento di Scienze Mediche e Chirurgiche, University of Bologna, St Orsola Hospital, Bologna, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Belluzzi
authors.affiliation: Gastroenterology Unit, Dipartimento di Scienze Mediche e Chirurgiche, University of Bologna, St Orsola Hospital, Bologna, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Bazzoli
authors.affiliation: Gastroenterology Unit, Dipartimento di Scienze Mediche e Chirurgiche, University of Bologna, St Orsola Hospital, Bologna, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Montagnani
mesh_terms: D015746:Abdominal Pain / Q000382:microbiology; D000208:Acute Disease; D000328:Adult; D002690:Chlamydia Infections / Q000175:diagnosis* / Q000382:microbiology*; D003937:Diagnosis, Differential; D005334:Fever / Q000382:microbiology; D006069:Gonorrhea / Q000150:complications*; D006505:Hepatitis / Q000175:diagnosis* / Q000382:microbiology*; D006801:Humans; D008297:Male; D000292:Pelvic Inflammatory Disease / Q000175:diagnosis* / Q000382:microbiology*; D010538:Peritonitis / Q000175:diagnosis* / Q000382:microbiology*; D014839:Vomiting / Q000382:microbiology
keywords: Fitz-Hugh-Curtis syndrome; Neisseria gonorrhoeae; abdominal pain; genitourinary symptoms; liver subcapsular fluid