Figure 1 Quiz of the Week

A 24-year-old sexually active female presents with a three-day history of severe right upper quadrant pain that worsens on inhalation. She has a history of multiple sexual partners and does not use contraception. Examination reveals marked tenderness in the right upper quadrant and laparoscopy demonstrates the findings seen here.

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Image credit: @OBMD.

Answer:  Cefoxitin and doxycycline

This patient’s presentation is suggestive of Fitz-Hugh-Curtis syndrome, an uncommon complication that occurs in 10 percent of women with pelvic inflammatory disease (PID). It is characterized by liver inflammation, causing right upper quadrant abdominal pain, often associated with pleuritic chest pain. Chlamydia trachomatis is the most common sexually transmitted infection associated with PID and is typically treated with a combination of cefoxitin and doxycycline. In cases like these, a full STI workup is indicated even in the presence of a classic syndrome.

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