Fitz-Hugh-Curtis Syndrome Symptoms and Diagnosis

Fitz-Hugh-Curtis syndrome is a condition in which bacteria, usually from a pelvic infection, spread through the abdomen and cause inflammation of the membrane lining of the stomach and of the tissue surrounding the liver. The diaphragm (the muscle that separates the stomach from the chest) may also be affected.

Also known as gonococcal perihepatitis or perihepatitis syndrome, Fitz-Hugh-Curtis syndrome is a rare disorder that occurs in 4% to 14% of women with pelvic inflammatory disease (PID), and up to 27% of adolescents with PID. On rare occasions, the disorder may also occur in women without PID and in men.

Woman with stomach ache
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In Fitz-Hugh-Curtis syndrome, the inflammation of the liver tissue leads to the formation of abnormal tissue connections (adhesions) between the outside of the liver and the inside of the abdomen. In some individuals, these adhesions cause no symptoms. Others may have some or all of the following symptoms associated with Fitz-Hugh-Curtis:

  • Sudden onset of severe pain in the upper right part of the abdomen, over the gallbladder
  • Pain that may have moved to the right shoulder and inside of right arm
  • Increasing pain with coughing, sneezing, or movement
  • Nausea
  • Vomiting
  • Chills and fever
  • Night sweats
  • Headaches
  • Hiccupping

Common Causes and Diagnosis

In general, a healthcare provider cannot see or feel the presence of Fitz-Hugh-Curtis syndrome, so upper abdominal pain may be the only way to suggest the direction of diagnosis.

The presence of a pelvic infection would also provide a clue to the diagnosis, as the disorder is most commonly a complication of pelvic inflammatory disease (PID), which is an infection of the upper genital tract in women. The Infection is most often caused by the bacteria Neisseria gonorrhoeae (gonorrhea) or Chlamydia trachomatis (chlamydia).

Without the presence of PID, diagnosis may be difficult, since many conditions can cause abdominal pain. In women, nucleic acid testing will be done to identify the presence of gonorrhea and chlamydia since these infections are the most common causes of Fitz-Hugh-Curtis syndrome. If infection is present, a blood test may show a slightly elevated white blood cell count (WBC) and erythrocyte sedimentation rate (ESR).

The healthcare provider will examine the individual for common conditions which have symptoms similar to Fitz-Hugh-Curtis syndrome, such as gallstones, liver inflammation (hepatitis), kidney stones or infection, and stomach ulcer. Abdominal ultrasound and computed tomography (CT) scan can help rule out these disorders. A chest X-ray can rule out pneumonia as a cause of pain with coughing or sneezing.

Laparoscopy to Confirm Diagnosis

The best way to confirm a diagnosis of Fitz-Hugh-Curtis syndrome is by having your healthcare provider take a look inside the body (to look at the liver). This is done by inserting a camera inside the abdomen, called laparoscopy. The healthcare provider can see the adhesions on the outside of the liver, which have a typical stringy look (called “violin-string” adhesions).


Treatment for the individual with Fitz-Hugh-Curtis syndrome consists of antibiotics for the infection and pain medicine. Once the infection is cleared up, the symptoms resolve. Since chlamydia and gonorrhea are spread through sexual contact, the individual must restrict her/his sexual activity until the infection is gone, and the individual’s sexual partner(s) must also be treated.

3 Sources
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  1. Khine H, Wren SB, Rotenberg O, Goldman DL. Fitz-Hugh-Curtis syndrome in adolescent females: a diagnostic dilemma. Pediatr Emerg Care. 2019;35(7):e121-e123. doi:10.1097/PEC.0000000000001525

  2. National Organization for Rare Disorders. Fitz Hugh Curtis syndrome.

  3. Ekabe CJ, Kehbila J, Njim T, Kadia BM, Tendonge CN, Monekosso GL. Chlamydia trachomatis-induced Fitz-Hugh-Curtis syndrome: a case report. BMC Res Notes. 2017;10(1):10. doi:10.1186/s13104-016-2357-z

By Mary Kugler, RN
Mary Kugler, RN, is a pediatric nurse whose specialty is caring for children with long-term or severe medical problems.