A 22-year-old woman with PID has the classic Fitz-Hugh-Curtis syndrome. Which pathogen is most commonly responsible for this perihepatitis?

• A Neisseria gonorrhoeae exclusively
• B Bacteroides fragilis and Peptostreptococcus
• C Chlamydia trachomatis (more common) or N. gonorrhoeae ✓
• D Mycoplasma genitalium

Explanation

Fitz-Hugh-Curtis syndrome (perihepatitis) is characterised by violin-string adhesions between the anterior liver capsule and the parietal peritoneum, causing right upper quadrant pain in women with PID. Chlamydia trachomatis is now recognised as the more common causative organism, although Neisseria gonorrhoeae was the classic cause historically. The adhesions result from direct spread of infection along the right paracolic gutter or haematogenous spread.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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