Kidney Research and Clinical Practice 2019 Dec; 38(4): 525-526  https://doi.org/10.23876/j.krcp.19.094
Fitz-Hugh-Curtis syndrome occurring after removal of a peritoneal catheter
Da Woon Kim1 , Sang Heon Song1,2
1Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
2Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
Correspondence to: Sang Heon Song
Department of Internal Medicine, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan 49241, Republic of Korea. E-mail: shsong0209@gmail.com

Edited by Sungjin Chung, The Catholic University of Korea, Seoul, Republic of Korea
Received: September 5, 2019; Revised: October 30, 2019; Accepted: October 30, 2019; Published online: December 31, 2019.
© The Korean Society of Nephrology. All rights reserved.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Body

Fitz-Hugh–Curtis syndrome (FHCS) is commonly associated with genital tract infection and presents as an inflammation and infection of the liver capsule. The clinical manifestation typically includes an acute onset of right upper quadrant (RUQ) abdominal pain. Computed tomography (CT) characteristically shows increased enhancement along the hepatic surface in the arterial phase and perihepatic fat stranding in the portal phase. We report an eccentric case of FHCS which unusually occurred after removal of a peritoneal catheter. A 59-year-old woman with diabetic nephropathy started automated peritoneal dialysis (APD) in 2015 because of end-stage kidney disease. While maintaining APD, she suffered from 3 episodes of peritonitis from 2015 to 2018.

In April 2019, she was admitted via the emergency room due to symptoms of general weakness and dyspnea. Because her peritoneal dialysis (PD) was not effective in eliminating excessive fluid volume, the peritoneal catheter was removed by open surgical dissection; however, the catheter tip culture was not performed. Then the patient was converted to hemodialysis. Immediately after removal of the peritoneal catheter, the patient did not show any of the signs and symptoms of infection. Two months later, however, she complained of RUQ pain and fever. CT showed hepatic capsular enhancement in the arterial phase (Fig. 1A), suggestive of FHCS. Pelvic inflammatory disease was ruled out through gynecological examination, including polymerase chain reaction analyses for microorganisms associated with sexually transmitted diseases from a cervico-vaginal smear. After a three-week course of ceftazidime and azithromycin, her symptoms were resolved and CT findings of hepatic capsular enhancement completely disappeared (Fig. 1B).

It is well known that FHCS is a pathology complicated by pelvic inflammatory disease and usually occurs in young women of child-bearing age. However, a rare case of FHCS consequent to a post-operative wound infection following catheter removal in a PD patient was reported. We assumed that FHCS in the present case was also complicated by a delayed post-operative micro-infection after peritoneal catheter removal, rather than by PD. Thus, FHCS should be considered in PD patients with pleuritic-type RUQ abdominal pain. Biphasic CT with arterial and portal phases could help to ensure an adequate diagnosis of FHCS.

figure

Arterial phases of computed tomography (CT) scan to diagnose Fitz-Hugh-Curtis syndrome. The arrows indicate linear enhancement along the hepatic surface (A). After antibiotic treatment, hepatic capsular enhancement disappeared (B).

Conflicts of interest

All authors have no conflicts of interest to declare.

Authors’ contributions

Da Woon Kim participated in the data collection and wrote the manuscript. Sang Heon Song provided intellectual content of critical importance to the work and technical support. All authors read and approved the final manuscript.



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