title: Fitz-Hugh-Curtis syndrome lacking typical characteristics of pelvic inflammatory disease.
abstract: A 23-year-old Japanese woman, previously a commercial sex worker, presented with a 2-day history of right upper quadrant (RUQ) abdominal pain, worse on deep inspiration. She had noticed increased vaginal discharge 2 months earlier and had developed dull, lower abdominal pain 3 weeks prior to presentation. Although pelvic examination and transvaginal ultrasonography revealed neither a tubal nor ovarian pathology, abdominal CT scan with contrast demonstrated early enhancement of the hepatic capsule, a finding pathognomonic for Fitz-Hugh-Curtis syndrome (FHCS). Cervical discharge PCR assay confirmed Chlamydia trachomatis infection. This case highlights that normal gynaecological evaluation may be insufficient to rule out FHCS, for which physicians should have a high index of suspicion when seeing any woman of reproductive age with RUQ pain.
authors.affiliation: Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba, Japan.
authors.forename: Hayato
authors.initials: H
authors.lastname: Mitaka
authors.affiliation: Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba, Japan.
authors.forename: Hidetaka
authors.initials: H
authors.lastname: Kitazono
authors.affiliation: Department of Internal Medicine, University of Hawaii, Honolulu, Hawaii, USA.
authors.forename: Gautam A
authors.initials: GA
authors.lastname: Deshpande
authors.affiliation: Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Hiraoka
mesh_terms: D015746:Abdominal Pain / Q000000981:diagnostic imaging* / Q000209:etiology; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002443:Ceftriaxone / Q000627:therapeutic use*; D002690:Chlamydia Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D002692:Chlamydia trachomatis / Q000302:isolation & purification*; D016358:Contact Tracing; D037001:Directive Counseling; D004318:Doxycycline / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006505:Hepatitis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D000292:Pelvic Inflammatory Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology; D010538:Peritonitis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D011477:Sex Work; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D002443:Ceftriaxone; D004318:Doxycycline