Fitz-Hugh-Curtis Syndrome Caused by Gonococcal Infection in a Patient with Systemic Lupus Erythematous: A Case Report and Literature Review
Challenging differential diagnosis, Rare co-existance of disease or pathology
Darío A. Rueda, Luisina Aballay, Lisandro Orbea, Diego A. Carrozza, Paola Finocchietto, Silvia B. Hernandez, Mariano M. Volpacchio, Horacio di Fonzo
Department of Internal Medicine, Hospital de Clínicas “Jose de San Martin”, University of Buenos Aires, Buenos Aires, Argentina
Am J Case Rep 2017; 18:1396-1400
Fitz-Hugh-Curtis (FHC) syndrome is a perihepatitis linked to inflammatory pelvic disease. It can be caused by Neisseria gonorrhoeae or Chlamydia trachomatis infections. FHC syndrome usually presents with pain in the right hypochondrium and fever, associated with symptoms and signs of pelvic infection in women.
CASE REPORT: We present the case of a 22-year-old woman with systemic lupus erythematous (SLE) who presented with polyarthritis, cutaneous lesions, and abdominal pain. The diagnosis of FHC syndrome was based on the findings of abdominal computerized tomography (CT) and the isolation of Neisseria gonorrhoeae (NG) in blood cultures. The association of arthritis and cutaneous lesions was diagnosed as a syndrome of arthritis-dermatitis, also caused by systemic NG infection. The patient had a favorable outcome with antibiotic treatment.
CONCLUSIONS: FHC syndrome should be considered in sexually active young patients, mainly women, with pelvic infection and perihepatitis. It may be caused by disseminated gonococcal infection. An important risk factor is the serum complement deficit, which may predispose to severe forms. Low serum complement level is a frequent manifestation of active SLE. CT images showing the typical findings of perihepatitis allow making the correct diagnosis.
Keywords: Gonorrhea, Lupus Erythematosus, Systemic, Peritoneal Diseases