Nardini Paola, Compri Monica, Marangoni Antonella, D'Antuono Antonietta, Bellavista Sara, Calvanese Claudio, Belluzzi Andrea, Bazzoli Franco, Montagnani Marco
Microbiology Unit, Dipartimento di Medicina Specialistica Diagnostica e Sperimentale, University of Bologna, St Orsola Hospital, Bologna, Italy.
Dermatology Unit, Dipartimento di Medicina Specialistica Diagnostica e Sperimentale, University of Bologna, St Orsola Hospital, Bologna, Italy.
J Emerg Med. 2015 Mar;48(3):e59-62. doi: 10.1016/j.jemermed.2014.04.043. Epub 2014 Dec 12.
Fitz-Hugh-Curtis syndrome is a rare extra-pelvic complication of genital infection involving the perihepatic capsule. Most cases have been described in women in association with pelvic inflammatory disease; in rare cases it has been reported in men. Because the main symptom is acute abdominal pain, and laboratory and imaging findings are frequently nonspecific, the differential diagnosis, considering other gastrointestinal or renal diseases, can be difficult in the early stage of the syndrome, leading to frequent misdiagnosis and mismanagement.
We report a case of Fitz-Hugh-Curtis syndrome in a 26-year-old man who first presented to the emergency department with acute abdominal pain, vomiting, and fever. Diagnosis was possible on the basis of clinical signs of orchiepididymitis, abnormal ultrasound findings, and specialist consultation with the Sexually Transmitted Infection Clinic. An acute gonoccocal infection was revealed, which was complicated by a collection of free perihepatic fluid and a subcapsular hypoechoic focal lesion. Prompt antibiotic therapy was established, with complete resolution of the symptoms within a few days. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Awareness of the clinical presentation, imaging, and laboratory findings during the acute phase of Fitz-Hugh-Curtis syndrome could help emergency physicians to make an early diagnosis and to correctly manage such patients. Improved diagnostic skills could prevent chronic complications that are especially a risk in the case of delayed or minor genitourinary symptoms.
菲茨-休-柯蒂斯综合征是一种累及肝包膜的罕见的生殖器感染盆腔外并发症。大多数病例见于患有盆腔炎的女性；罕见情况下也有男性病例的报道。由于主要症状是急性腹痛，且实验室和影像学检查结果往往不具有特异性，在该综合征早期，考虑到其他胃肠道或肾脏疾病进行鉴别诊断可能较为困难，常导致误诊和治疗不当。
我们报告一例26岁男性菲茨-休-柯蒂斯综合征病例，该患者最初因急性腹痛、呕吐和发热就诊于急诊科。根据睾丸炎附睾炎的临床体征、异常超声检查结果以及与性传播感染诊所的专家会诊得以确诊。检查发现急性淋球菌感染，并伴有肝周游离液体聚集和包膜下低回声局灶性病变。随即开始进行抗生素治疗，数天内症状完全缓解。急诊医生为何应了解此病症？：了解菲茨-休-柯蒂斯综合征急性期的临床表现、影像学和实验室检查结果有助于急诊医生早期诊断并正确处理此类患者。提高诊断技能可预防慢性并发症，尤其是在泌尿生殖系统症状延迟出现或症状较轻的情况下，慢性并发症风险更高。
