Diagnostic challenge of chlamydial Fitz-Hugh-Curtis syndrome and cervicitis complicated by appendicitis: Case report

Our patient had appendicitis complicated by Chlamydia trachomatis-induced Fitz-Hugh-Curtis syndrome and cervicitis. Differential diagnosis was challenging. A 22-year-old Japanese woman was febrile and presented with vomiting and subsequent abdominal pain. She had unprotected sexual intercourse with multiple partners. She had high Alvarado score and lack of cervical motion pain, despite cervical inflammation. Noncontrast CT showed enlarged appendix. Laparoscopic appendectomy revealed acute suppurative appendicitis and perihepatic adhesion. Cervical PCR assay was positive for C. trachomatis. She remained febrile but defervesced after azithromycin therapy. Clinicians should confirm whether females with abdominal pain are sexually active in view of screening for C. trachomatis.