Question
35 yr old woman visits ER with the C/o pain in the right upper abdomen, fever and vomiting. She has a history of white discharge since 3 months. Cervical swab revealed the presence of intracellular diplococci. What is the most likely sequelae causing the symptoms?
| A. |
Subphrenic abscess |
| B. |
Liver abscess |
| C. | Cholecystitis |
| D. |
Fitz-Hugh-Curtis syndrome |
|
Correct Answer » D Explanation |
 |
– White vaginal discharge for 3 months → suggests sexually transmitted infection (STI)
– Intracellular diplococci on cervical swab → classic for Neisseria gonorrhoeae
– Right upper quadrant (RUQ) pain + above findings → strongly suggests Fitz-Hugh-Curtis syndrome
Fitz-Hugh-Curtis Syndrome
– Perihepatitis as a complication of pelvic inflammatory disease (PID)
– Most common organisms: Neisseria gonorrhoeae & Chlamydia trachomatis
Pathophysiology
– Ascending infection: cervicitis → PID → spreads via peritoneal cavity → inflammation of liver capsule (perihepatitis)
– Liver parenchyma remains normal; only the capsule is inflamed
Clinical Features
– RUQ pain, fever, vaginal discharge, pelvic pain, signs of PID
– Laparoscopy shows “violin-string adhesions” between liver capsule & abdominal wall
Option Analysis
A. Subphrenic abscess
– Usually follows abdominal surgery, peritonitis, or trauma
– Not linked to gonorrhea or vaginal discharge
B. Liver abscess
– Caused by amoebic (Entamoeba histolytica) or pyogenic infection
– Causes hepatomegaly, severe fever, tender liver
– Not related to intracellular diplococci
C. Cholecystitis
– Caused by gallstones
– Presents with RUQ pain, Murphy sign, fatty meal intolerance
– No relation to cervical infection