Fitz-Hugh-Curtis Syndrome: A Rare Complication of PID

Pelvic inflammatory disease (PID) is an infection of a woman's reproductive organs. If PID spreads, it can lead to Fitz-Hugh-Curtis syndrome, also known as gonococcal perihepatitis and perihepatitis syndrome.

This condition is rare and almost exclusive to women, but here's what you should know, starting with an explanation of PID and how complications can arise.

What is PID?

PID is an infection of the upper genital tract in women. It occurs when bacteria, typically from a sexually transmitted infection (STI), make their way past the cervix and into the uterus, fallopian tubes or ovaries. Normal bacteria can cause PID if they're pushed into a woman's reproductive organs because of douching. However, the upper genital tract can be infected by normal bacteria from sources beyond douching, such as instrumentation with septic abortions or intrauterine devices (IUDs).

PID can sometimes resolve on its own, but treatment in the form of antibiotics is recommended.

What leads to Fitz-Hugh-Curtis syndrome?

Fitz-Hugh-Curtis syndrome is a complication of PID. If the bacteria from PID spread through the abdomen, they can inflame both the lining of the stomach and the tissue around the liver. They can also affect the diaphragm.

The STIs gonorrhea and chlamydia are often culprits that can lead to PID, which can then lead to Fitz-Hugh-Curtis syndrome.

About 4 to 15 percent of women with PID will develop Fitz-Hugh-Curtis syndrome. The condition rarely occurs in women without PID or in men.

What are the symptoms and diagnosis?

Fitz-Hugh-Curtis syndrome causes liver inflammation, which leads to abnormal tissue connections, called adhesions, from the liver to other areas of the abdomen, such as the abdominal wall and diaphragm. These connections may or may not cause any symptoms.

The symptoms include severe pain in the upper right area of the abdomen that may move to the right shoulder or arm; intense pain when you move, cough or sneeze; nausea, vomiting, chills, fever, headaches and hiccupping.

If your doctor thinks you have Fitz-Hugh-Curtis syndrome, they will test cervical cultures for gonorrhea and chlamydia, which can indicate PID.

If you don't have PID, diagnosing Fitz-Hugh-Curtis syndrome can be difficult. Your doctor may instead examine you for gallstones, kidney stones, stomach ulcers, infection or hepatitis, because these conditions have similar symptoms and occur in the same area. By ruling out other conditions, your doctor can better determine whether you have Fitz-Hugh-Curtis syndrome.

A laparoscopy can help your doctor take a look at your liver to confirm the diagnosis. Adhesions, which look like violin strings around the liver, and scar tissue need to be seen directly and would not be seen by ultrasound.

What's the outlook?

Fitz-Hugh-Curtis syndrome can be treated with antibiotics and pain medication. If the infection clears up, the symptoms will, too. If gonorrhea or chlamydia led to your Fitz-Hugh-Curtis syndrome, you'll have to wait to have sex until the infection has cleared up. Your sexual partner(s) will also need antibiotics for treatment of either of those infections.

If you don't respond to antibiotic treatment, your doctor may perform a laparoscopy or open laparotomy, where the scar tissue or adhesions around the liver are removed.

You will likely never develop Fitz-Hugh-Curtis syndrome, but it's important to be aware of the condition, especially if you have PID. The symptoms can easily be confused with other abdominal disorders, but with some testing, your doctor can determine which disorder you have and your best course of treatment.