Fitz-Hugh–Curtis syndrome (FHCS) is defined by the sign of perihepatic (violin-string) adhesions extending from the parietal peritoneum of the anterior abdominal wall to the anterior liver (Glisson) capsule and symptoms of right upper quadrant abdominal pain as well as those, most commonly, referable to a pelvic inflammatory disease (PID) process. Lam et al reported the case of a 19-year-old female diagnosed with FHCS presenting with diffuse abdominal pain.1 We believe that this case may represent an “atypical” presentation of a pyogenic PID complicated by peritonitis with secondary small bowel involvement and perihepatic adhesion but not FHCS.