Acute Fitz-Hugh-Curtis syndrome in a man due to gonococcal infection

Ultrasound findings of Fitz-Hugh-Curtis Syndrome (FHCS) associated with splenic tuberculosis in an HIV-positive male patient

Fitz-Hugh-Curtis (FHCS) is characterized by an inflammation of the hepatic capsule concomitant or following pelvic infection due to Chlamydia trachomatis or Neisseria gonorrhea. It is a rare condition occurring most often in a woman of childbearing age and very rare in male patients. Splenic involvement is also a rare form of abdominal tuberculosis. The association of these two conditions is very uncommon. We report the exceptional case of a 58- year-old HIV-positive male patient, with whom abdominal ultrasound helped diagnose FHCS associated with abdominal tuberculosis invovlving the spleen.

Perihepatitis as an Initial Manifestation of Systemic Lupus Erythematosus

A 25-year-old man presented with a fever and right upper quadrant abdominal pain. Computed tomography (CT) of the abdomen revealed diffuse perihepatic capsular enhancement, suggesting perihepatitis. Although the patient was a man, Fitz-Hugh-Curtis syndrome was suspected based on the CT findings. Treatment with several antibiotics was ineffective. Urinary tract infection was ruled out due to negative urinary bacterial screening and careful history taking. He was finally diagnosed with systemic lupus erythematous (malar rash, pleuritis, positive antinuclear antibody, and positive anti-ds-DNA antibody). Perihepatitis resolved quickly with high-dose prednisolone. Perihepatitis may be the first manifestation of SLE.

Mpox proctitis as a likely predisposing factor for chlamydial perihepatitis in a male patient

Perihepatitis (Fitz-Hugh-Curtis syndrome) is a rare complication of sexually transmitted infections, mostly seen in women. Only 12 male cases have been reported to date, of which Chlamydia trachomatis was confirmed in 2. We report a case of chlamydial perihepatitis in a male patient, occurring 1 month after Mpox and associated with the unusual LGV ST23 strain. Our case suggests that rectal Mpox lesions may facilitate chlamydial dissemination.

A rare case of Fitz-Hugh-Curtis syndrome caused by Chlamydia trachomatis in an HIV-positive male patient

Fitz-Hugh–Curtis syndrome, a rare complication of pelvic inflammatory disease, is an inflammation of the liver capsule (thus called perihepatitis) and the surrounding peritoneum. It occurs extremely rarely in men and is typically characterized by a sudden onset of severe pain in the right upper abdominal quadrant. Ultrasound examination of the liver does not reveal any morphologic changes, and liver function tests are usually normal. Computerized tomography shows the thickening of the perihepatic fat, but definitive diagnosis is only possible by direct visualization by laparoscopy or laparotomy. We present a 33-year-old HIV-positive man with Chlamydia trachomatis proctitis who developed severe right upper abdominal quadrant pain. Abdominal ultrasound did not show any liver pathology, while computerized tomography revealed hepatic capsular thickening. After 21 days of doxycycline therapy, the patient’s symptoms subsided. Based on the clinical presentation and liver computerized tomography examination, the diagnosis of proctitis and the resulting Fitz-Hugh–Curtis syndrome was made. Although it is rarely seen in male patients, it should be a part of differential diagnosis in patients who present with right upper abdominal quadrant pain, especially in men who have sex with other men.

Fitz-Hugh-Curtis syndrome in a man positive for Chlamydia trachomatis

Fitz-Hugh-Curtis syndrome (FHCS) is characterized by perihepatic and pelvic inflammation and occurs mostly in women of childbearing age. Here, we report a case of FHCS caused by Chlamydia trachomatis in a 50-year-old man. The patient presented to our hospital with right upper quadrant abdominal pain, and enhanced computed tomography revealed perihepatic and pelvic free fluid and early-phase hepatic capsular enhancement. A urine specimen was positive for Chlamydia trachomatis. The patient was diagnosed with FHCS due to Chlamydia trachomatis infection. In conclusion, FHCS cannot be excluded when men present with right upper quadrant abdominal pain without significant signs of biliary tract disease.

Vasitis mimicking an Amyand's hernia: A case report

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Amyand’s hernia is an inguinal hernia containing the caecal appendix.

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Radiologically a tubular structure is found inside the inguinal canal.

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However, other conditions may show similar radiological findings.

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Anamnesis and physical examination are essential for an accurate diagnosis.

Introduction

Amyand’s hernia is an inguinal hernia containing the caecal appendix. It is usually an intraoperative finding, although it can be diagnosed preoperatively with radiologic examinations, which would show a tubular structure inside the inguinal canal.

Presentation of case

A male patient presented to the emergency department complaining of abdominal pain in the right lower quadrant. He had been orchidectomized during his childhood due to cryptorchidism, and had been under antibiotic treatment a week before due to a suspected gonorrhoea. A small irreductible mass was found in the right groin. Blood tests showed leucocytosis and elevated CRP. A CT-scan was performed, reporting a tubular structure with a blind end entering the inguinal canal that seemed to be the appendix. Single-port laparoscopic exploration was indicated, and a right vasitis was found instead of an Amyand’s hernia. After the operation, the patient explained that he had not taken the antibiotics for the gonorrhoea.

Discussion

Untreated gonorrhoea causes ascendant vasitis and orchyepididimitis. In the present case, since the patient did not have testicles, the inflamed vas deferens mimicked the Appendix inside the inguinal canal. If the patient had told the truth about the untreated gonorrhoea, maybe the condition would have been suspected and no radiological examinations would have been performed, which subsequently lead to an unnecessary operation.

Conclusion

Presently, Amyand’s hernia is more frequently diagnosed preoperatively than intraoperatively. However when an Amyand’s hernia is preoperatively suspected, the possibility of a vasitis should always be ruled out in order to avoid unnecessary operations.