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29 December 2017 : Case report  Argentina

Fitz-Hugh-Curtis Syndrome Caused by Gonococcal Infection in a Patient with Systemic Lupus Erythematous: A Case Report and Literature Review

Challenging differential diagnosis, Rare coexistence of disease or pathology

Darío A. Rueda1ABDEF, Luisina Aballay1ABDEF, Lisandro Orbea1BF, Diego A. Carrozza1ADF, Paola Finocchietto1ADF, Silvia B. Hernandez1BDF, Mariano M. Volpacchio2DF, Horacio di Fonzo1ABDEFG*

DOI: 10.12659/AJCR.906393

Am J Case Rep 2017; 18:1396-1400

Abstract

BACKGROUND: Fitz-Hugh-Curtis (FHC) syndrome is a perihepatitis linked to inflammatory pelvic disease. It can be caused by Neisseria gonorrhoeae or Chlamydia trachomatis infections. FHC syndrome usually presents with pain in the right hypochondrium and fever, associated with symptoms and signs of pelvic infection in women.

CASE REPORT: We present the case of a 22-year-old woman with systemic lupus erythematous (SLE) who presented with polyarthritis, cutaneous lesions, and abdominal pain. The diagnosis of FHC syndrome was based on the findings of abdominal computerized tomography (CT) and the isolation of Neisseria gonorrhoeae (NG) in blood cultures. The association of arthritis and cutaneous lesions was diagnosed as a syndrome of arthritis-dermatitis, also caused by systemic NG infection. The patient had a favorable outcome with antibiotic treatment.

CONCLUSIONS: FHC syndrome should be considered in sexually active young patients, mainly women, with pelvic infection and perihepatitis. It may be caused by disseminated gonococcal infection. An important risk factor is the serum complement deficit, which may predispose to severe forms. Low serum complement level is a frequent manifestation of active SLE. CT images showing the typical findings of perihepatitis allow making the correct diagnosis.

Keywords: Gonorrhea, Lupus Erythematosus, Systemic, Peritoneal Diseases

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923