Health A-Z

Fitz-Hugh-Curtis syndrome (FHCS) is a rare complication of pelvic inflammatory disease (PID) characterized by inflammation of the liver capsule (perihepatitis) and the surrounding peritoneum. Here's an overview of its symptoms, treatment plan, diagnosis, and testing.

Symptoms

FHCS commonly causesTrusted Source a person to experience right upper quadrant abdominal pain. This is due to the inflammation of the liver capsule and the adhesion of the space between the liver capsule and the parietal peritoneum. The parietal peritoneum refers to the layers of tissueTrusted Source that line the abdominal wall. A person’s right upper quadrant abdominal pain usually becomes worseTrusted Source with movement and breathing.

Other possible symptoms of FHCS may include:

• lower abdominal pain
• pelvic pain
• back pain
• fever
• chills
• nausea and vomiting
• vaginal discharge
• painful sexual intercourse, which doctors call dyspareunia
• painful urination, which doctors call dysuria
• cramping
• bleeding after sexual intercourse

Treatment options

A doctor will often treat a person’s PID alongside their FHCS. The main aims of treatment includeTrusted Source:

• relieving symptoms
• eradicating the infection
• minimizing the risks of long-term complications, such as infertility or ectopic pregnancy

A doctor will most often use antibiotics to treat the infection. This treatment is typically effective, and most people with PID can receive treatment as outpatients.

A doctor may wish to treat a person in a hospital if they:

• have an uncertain diagnosis
• are pregnant
• are displaying signs of a severe illness
• have pelvic abscesses
• are unable to tolerate taking medications orally
• have an immunodeficiency
• show no signs of improvement after 72 hours of treatment

Diagnosis

FHCS may have similar symptoms to several other conditions. As such, a doctor may carry out a differential diagnosis to rule out the following conditionsTrusted Source when making a diagnosis:

• ectopic pregnancy
• cholecystitis, swelling or inflammation of the gallbladder
• viral hepatitis
• renal colic
• pyelonephritis, a kidney infection due to bacteria or a virus
• pulmonary embolism
• appendicitis

During a diagnosis, a doctor may carry out one of the following lab tests:

• Pregnancy test: A doctor may carry out a pregnancy test to guide their choice of antibiotic therapy and help address whether the person has an ectopic pregnancy.
• Complete blood count (CBC): A doctor may use a CBC to look for a high white blood cell count. Around 50% of people with PID have a significantly raised white blood cell count.
• Comprehensive metabolic panel: This test can help a doctor assess a person’s electrolyte levels as well as any atypical liver or kidney readings.
• Sexually transmitted infection test: This can test for chlamydia and gonorrhea, which can indicate that a person may have FHCS.

A doctor may also carry out a CT scan. This scan usesTrusted Source detail from several X-rays to create detailed images of structures inside the body. A doctor may use a CT scan to look for increased blood flowTrusted Source in the liver capsule due to the inflammation. This can help a doctor make an early diagnosis of FHCS.

A doctor may also use a laparoscopy to help make a diagnosis. During this procedure, a doctor insertsTrusted Source a laparoscope through a small incision. The laparoscope has a small light and a camera on the end, which allows healthcare professionals to see inside the body. A doctor can use a laparoscopy to look for adhesion between the diaphragm and liver or the liver and the anterior abdominal wall, which are often present in people with FHCS.