A 24-year-old woman presents with right upper quadrant pain, fever, and a 'violin-string' adhesion between the liver capsule and anterior abdominal wall seen at laparoscopy. Cervical cultures grow gram-negative diplococci that ferment glucose but not maltose. What is the most likely diagnosis?

• A Perihepatitis due to Chlamydia trachomatis
• B Fitz-Hugh-Curtis syndrome due to Neisseria gonorrhoeae ✓
• C Pyogenic liver abscess due to Klebsiella pneumoniae
• D Pelvic inflammatory disease with reactive hepatitis due to Neisseria meningitidis

Explanation

The violin-string peritoneal adhesion defines Fitz-Hugh-Curtis perihepatitis, classically a complication of gonococcal pelvic inflammatory disease. The isolate ferments glucose alone, which distinguishes N. gonorrhoeae from N. meningitidis (glucose and maltose). Chlamydia can cause perihepatitis but would not yield gram-negative diplococci on cervical culture, which kills the most tempting distractor.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.