Introduction

Inflammation of the liver capsule resulting from Pelvic Inflammatory Disease (PID) is known as Fitz-Hugh-Curtis syndrome (FHCS). PID is a condition that causes pain and swelling of the reproductive tract due to bacterial infections. The inflammation that starts when one has FHCS extends to the tissue surrounding the liver, causing stringy, sticky strands. These adhesive fibres bind your liver capsule to the inside of your abdomen or diaphragm, the muscle that controls breathing. FHCS is a consequence of sexually transmitted diseases (STIs) such as chlamydia and gonorrhoea, albeit it is not common.¹

Understanding Fitz-Hugh-Curtis syndrome

Most cases of Fitz-Hugh-Curtis syndrome are caused by an infection with either Chlamydia trachomatis, which causes chlamydia, or Neisseria gonorrhoeae, which causes gonorrhoea. Two frequently sexually transmitted diseases (STDs) are Chlamydia and Gonorrhea. Researchers think that Chlamydia trachomatis infections account for a greater proportion of Fitz-Hugh-Curtis syndrome cases than Neisseria gonorrhoeae infections. The precise mechanism via which these infections result in Fitz-Hugh-Curtis syndrome (pathogenesis) remains unclear. According to some studies, the infection of the liver and surrounding tissue happens as a result of bacteria that either go directly from the pelvis to the liver or via the bloodstream or lymphatic system.

Fitz-Hugh-Curtis syndrome has been linked by some researchers to an inappropriate immune system reaction (autoimmunity) to a Neisseria gonorrhoeae or Chlamydia trachomatis infection. Autoimmune disorders result from the abrupt attack of perfectly healthy tissue by the body's defence mechanisms, such as lymphocytes, antibodies, and other defence mechanisms against external intruders. Fitz-Hugh-Curtis syndrome patients had significant levels of antibodies against Chlamydia trachomatis, according to several investigations. To find out how autoimmunity contributes to the development of Fitz-Hugh-Curtis syndrome, more research is required.²

Chronic pelvic pain: An overview

Pelvic pain is commonly associated with pain in the reproductive organs of women and those assigned female at birth (AFAB), it can affect both sexes and be caused by a variety of different factors. Pelvic discomfort may originate from pain in your non-reproductive internal organs or pelvic bone, or it may be a sign of an infection. However, pelvic pain in female patients may be a sign of a possible issue with one of the pelvic reproductive organs (uterus, ovaries, fallopian tubes, cervix, and vagina).

Chronic pelvic discomfort is a complex health issue. Tests may occasionally reveal that a particular illness is the root reason, however, In other situations, the discomfort could be caused by multiple medical conditions. For instance, you may have interstitial cystitis or endometriosis, both of which can contribute to persistent pelvic pain.

The following are a few conditions that could be responsible for persistent pelvic pain:

1. Endometriosis - This is a condition in which tissue resembling the uterine lining grows outside the body. Infertility or suffering could result from it
2. Bone and muscle issues- Periodontal disease, osteoarthritis, and connective tissue disorders can cause persistent pelvic pain. These issues include hernias, pubic joint swelling, fibromyalgia, and tension in the pelvic floor muscles
3. Pelvic inflammation is a chronic illness, this may occur if a protracted infection (which is frequently transmitted during intercourse) leads to pelvic organ scarring
4. Leftover ovarian tissue - It is possible for a tiny bit of ovary to inadvertently remain inside following surgery to remove one or both ovaries. This remaining tissue may later develop into excruciating cysts
5. Fibroids - These are not cancerous growths on, inside, or connected to the uterus. However, they could result in lower back or lower stomach pressure or heaviness. They rarely hurt sharply
6. Risk factors for mental health - Your chance of developing chronic pelvic discomfort may be increased by depression, prolonged stress, or a history of physical or sexual abuse. Pain might worsen due to emotional distress. Also, chronic pain might exacerbate distress. These two elements frequently spiral into one another³

Diagnostic approaches

Fitz-Hugh-Curtis syndrome can often be difficult to diagnose since its symptoms resemble those of numerous other illnesses. To get an accurate diagnosis, your doctor might need to run several laboratory tests on you and rule out other disorders.

Some examples of laboratory testing are as follows:

1. Pregnancy examination
2. Total blood count
3. Comprehensive metabolic panel: a blood test that provides your doctor with specific details about the operations of your body
4. Vaginal smear
5. Sexually transmitted infection tests

A radiological examination could consist of:

1. CT scan
2. Transvaginal sonography examination
3. MRI

Among the illnesses with comparable symptoms are:

1. Ectopic conception
2. Cholecystitis
3. Hepatitis caused by virus
4. Colic in the kidneys
5. Infection of the kidneys
6. Embolism in the lung
7. The appendicitis

Your physician will either do standard or laparoscopic surgery if the diagnosis is still unclear. A confirmation of Fitz-Hugh-Curtis syndrome will come from identifying the violin string-like strands.¹

Management strategies

Typically, an antibiotic would be administered intravenously (IV) or as a tablet. Painkillers may also be prescribed by your physician. To remove scar tissue surrounding your liver, your doctor might conduct a laparoscopy if treating the underlying STI doesn't relieve your abdominal pain. A tiny, thin instrument will be inserted through a tiny incision made in your abdomen to remove the dead tissue, or "adhesions," during the surgery. This is rarely done.

Since PID is associated with this condition, avoiding PID is the best strategy to prevent it. You can lower your risk by:

1. Use condoms and don't have too many sexual partners
2. If you engage in sexual activity, get tested for STIs regularly
3. Ask your partners to be tested as well
4. Douching might increase your risk of vaginal infections, so avoid it⁴

Summary

FHCS is a rare and potentially serious complication in Pelvic Inflammatory Disease that primarily affects women. It happens when a PID extends to the liver, inflaming the tissues that surround the liver. Uncomfortable symptoms like excruciating pain in the right upper abdomen quadrant are frequently brought on by this.

Blood and imaging tests can be performed by a physician to aid in the diagnosis of FHCS. A laparoscopy is typically used by a medical expert to confirm the diagnosis of this condition. Antibiotics are frequently used in the treatment of FHCS to both reduce symptoms and get rid of the infection that is causing the PID. Antibiotics are frequently effective in treating FHCS, resulting in a full recovery with no long-term problems.