Fitz-Hugh-Curtis syndrome is best described as which of the following?

• A. A perihepatic inflammation associated with hepatobiliary parenchymal disease
• B. Perihepatitis caused by ascending gonococcal infection in women
• C. Acute cholecystitis with RUQ pain
• D. A hepatic abscess due to polymicrobial infection

Answer: (B)

This question focuses on recognizing that Fitz-Hugh–Curtis syndrome is a perihepatitis arising from an ascending gonococcal infection in women with pelvic inflammatory disease. The inflammation affects the liver’s capsule (the peritoneal surface around the liver) rather than the liver tissue itself, leading to right upper quadrant pain often in the context of PID. Liver function tests may be normal or only mildly abnormal, and a classic finding is “violin-string” adhesions between the liver and the parietal peritoneum seen on laparoscopy. The underlying pathogen is typically Neisseria gonorrhoeae or Chlamydia trachomatis, transmitted sexually. This distinguishes it from conditions like gallbladder inflammation or hepatic abscess, which involve different tissues and clinical patterns.