A 26-year-old woman undergoes laparoscopy for pelvic pain and bilateral adnexal tenderness. The finding of violin-string adhesions between the liver capsule and anterior abdominal wall is noted along with bilateral tubal inflammation. This specific finding is called the Fitz-Hugh-Curtis syndrome. The pathogen most commonly responsible in the current era is:

• A Neisseria gonorrhoeae — ascending pelvic infection with perihepatitis
• B Mycobacterium tuberculosis — perihepatitis as part of genital TB spread
• C Actinomyces israelii — IUD-related PID with characteristic 'sulfur granules' perihepatitis
• D Chlamydia trachomatis — the commonest current cause of perihepatitis ✓

Explanation

Fitz-Hugh-Curtis syndrome (perihepatitis) is characterized by right upper quadrant pain and laparoscopic finding of perihepatic violin-string adhesions. While originally described in association with gonorrhea, Chlamydia trachomatis is now the most frequently identified pathogen in the current era, accounting for the majority of cases. The mechanism involves direct extension of chlamydial infection from the upper genital tract to the peritoneal surface of the liver via the right paracolic gutter. Serological evidence of C. trachomatis is found in the majority of Fitz-Hugh-Curtis cases diagnosed today.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.