MCQ – 99281

Fitz-Hugh–Curtis syndrome, characterized by perihepatitis and right upper quadrant abdominal pain, is most commonly associated with which of the following infections?

Correct Answer » D Explanation

Fitz-Hugh–Curtis syndrome (FHCS) is a complication of pelvic inflammatory disease (PID) characterized by:

• Perihepatitis (inflammation of the liver capsule)
• Right upper quadrant abdominal pain
• “Violin-string” adhesions between the liver capsule and the anterior abdominal wall or diaphragm

The syndrome most commonly results from ascending genital tract infection caused by:

• Neisseria gonorrhoeae
• Chlamydia trachomatis (currently the most common cause)

Since Chlamydia is not among the options, Gonorrhea is the correct answer.

Explanation of Each Option

A. Moniliasis (Candidiasis) — Incorrect

• Caused by Candida albicans.
• Produces:
  • Thick curdy white vaginal discharge
  • Vulval itching
  • Dyspareunia
• Does not cause PID or perihepatitis.

B. Syphilis — Incorrect

• Caused by Treponema pallidum.
• Characterized by painless chancre, rash, and systemic manifestations.
• Does not cause Fitz-Hugh–Curtis syndrome.

C. Tuberculosis — Incorrect

• Genital tuberculosis can cause infertility and chronic PID.
• Rarely, perihepatitis resembling Fitz-Hugh–Curtis syndrome may occur in endemic areas.
• However, it is not the most common cause.
• The uploaded notes mention that tuberculosis can occasionally produce a similar syndrome, but gonococcal and chlamydial infections are the classic causes.

D. Gonorrhea — Correct

• Caused by Neisseria gonorrhoeae.
• Common cause of PID.
• Infection may spread from the pelvis to the liver capsule, causing perihepatitis and right upper quadrant pain.
• Gonorrhea is one of the classical organisms associated with Fitz-Hugh–Curtis syndrome.