Acute abdominal pain in a 24-year-old woman: Fitz-Hugh-Curtis syndrome associated with pyelonephritis

Fitz-Hugh-Curtis syndrome is an inflammatory disease of the liver capsule that occurs as a complication of pelvic inflammatory disease in approximately 25% of cases. The most common etiological agents are Chlamydia trachomatis and Neisseria gonorrhoeae. Classically, it manifests as acute right upper quadrant pain, which can sometimes be confused with pyelonephritis or a primitive condition of hepatobiliary origin or the digestive tract. A correct diagnosis is often difficult. Ultrasonography and computed tomography (CT) may be helpful in the differential diagnosis of other forms of peritonitis localized in the right abdominal quadrants, and serology, urine cultures and cervical swabs are generally used to isolate the responsible organism. The differential diagnosis could include Chilaiditi syndrome (interposition of a colonic segment between the liver and diaphragm with occlusion) or exudative peritonitis from salpingitis. We describe the clinical case of a 24year-old Caucasian woman who presented with acute right upper quadrant pain, positive Murphy’s sign, neutrophilic leukocytosis, and fever.