PMC3596056_01
Clinical course and the changes in white blood cell count in the peripheral blood (WBC), C-reactive protein level (CRP).. Notes: Although treatment with azithromycin (AZM) followed by levofloxacin (LVFX) decreased the vaginal discharge and improved the systemic inflammatory findings, the low grade fever persisted as did the right lower abdominal pain. However, treatment with ceftriaxone (CTRX), followed by cefditoren pivoxil (CDTR-PI) completely resolved the symptoms, and there were no further signs of recurrence.. Abbreviations: AZM, azithromycin; LVFX, levofloxacin; CTRX, ceftriaxone; CDTR-PI, cefditoren pivoxil; RUQ, right upper quadrant; RLQ, right lower quadrant; WBC, white blood cell count in the peripheral blood; CRP, C-reactive protein.
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A 27-year-old woman came to our outpatient clinic because of a low grade fever and increased vaginal discharge that developed 2 weeks prior to her visit (Fig. 1). Since C. trachomatis is the pathogen most often responsible for the syndrome, a single dose oral administration of azithromycin (1.0 g) was empirically initiated immediately after the diagnosis, followed by oral administration of levofloxacin (500 mg/day) for the next 7 days (Fig. 1). Although the cervical bacterial culture and serologic tests for C. trachomatis later proved negative, treatment with the antibiotics decreased her vaginal discharge and ameliorated the right upper abdominal pain, together with improvement of the systemic inflammatory findings (Fig. 1). Alternatively, we conservatively managed the patient with intravenous administration of ceftriaxone (1.0 g/day), followed by oral administration of cefditoren pivoxil (300 mg/day) (Fig. 1).
Computed tomography (CT) scan image on initial presentation.. Note: A computed tomography (CT) image showing hepatomegaly with a hepatic capsular enhancement in the arterial phase (white arrows).
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AST 44 IU/l), although other routine laboratory investigations, including blood glucose level, electrolytes, and renal function tests, were normal. Although ultrasound investigation of the uterus and adnexa was unremarkable, an abdominal computed tomography (CT) scan showed hepatomegaly with a hepatic capsular enhancement in the arterial phase (Fig. 2), indicating perihepatitis. Based on her clinical manifestations and typical CT findings (Fig. 2), a diagnosis of Fitz-Hugh-Curtis syndrome was made.
CT scan image after 7 days of levofloxacin treatment.. Note: A CT image showing an enlarged appendix with wall thickening (white arrow).
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Since an abdominal CT scan demonstrated an enlarged appendix with wall thickening (Fig. 3), she was additionally diagnosed as appendicitis.