Retroperitoneal Fibrosis in a Patient with Rheumatoid Arthritis

Yoo-Jeong Oh; Won-Seok Lee; Mi-Hee Kang; Joo-Hee Hwang; Wan-Hee Yoo

doi:10.4078/jrd.2015.22.6.391

Journal List > J Rheum Dis > v.22(6) > 1064233

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Oh, Lee, Kang, Hwang, and Yoo: Retroperitoneal Fibrosis in a Patient with Rheumatoid Arthritis

Case Report

J Rheum Dis 2015;22(6):391-394.

Published online: 31 October 2015

DOI: https://doi.org/10.4078/jrd.2015.22.6.391

Retroperitoneal Fibrosis in a Patient with Rheumatoid Arthritis

Yoo-Jeong Oh, Won-Seok Lee, Mi-Hee Kang, Joo-Hee Hwang, Wan-Hee Yoo

Division of Rheumatology, Department of Internal Medicine, Chonbuk National University Hospital, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea

Corresponding to: Wan-Hee Yoo, Division of Rheumatology, Department of Internal Medicine, Chonbuk National University Hospital, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju 54907, Korea. E-mail: ywhim@jbnu.ac.kr

Received 2 February 2015 Revised 16 March 2015 Revised 23 March 2015 Accepted 24 March 2015

This is a Free Access article, which permits unrestricted non-commerical use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

A 54-year-old male diagnosed with rheumatoid arthritis (RA) was effectively treated with methotrexate and adalimumab. He was admitted with fatigue and right lower back pain which had persisted for 1 month. An enhanced abdominal computed tomography scan showed an ill-defined mass with soft tissue attenuation surrounding the right common iliac artery involving the right middle portion of the ureter. Laparoscopic ureterolysis and biopsy were performed. Microscopic evaluation confirmed the presence of fibroblastic proliferation, with a pleomorphic inflammatory cell infiltrate consisting predominantly of lymphocytes, macrophages, and vascular endothelial cells, without granuloma or neoplastic cells. Therefore, our diagnosis was retroperitoneal fibrosis (RPF)-associated RA. Clinicians should consider the possibility of RPF in patients with RA who experience lower back pain, abdominal pain, or dysuria, and order suitable imaging studies.

Keywords: Retroperitoneal fibrosis, Rheumatoid arthritis

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Figure 1.

(A) A computed tomography (CT) scan showing a retroperitoneal mass encircling the right common iliac artery, encasing the middle portion of the right ureter (arrow), (B) and resulting in hydronephrosis (arrow). (C) A CT scan after 3 months showing a decreased mass of retroperitoneal fibrosis encircling the right common iliac artery and ureter (arrow). (D) In addition, hydro-nephrosis has been relieved (arrow).

Figure 2.

A biopsy specimen from the affected area demonstrating extensive fibrosis with lymphocytes and plasma cell infiltrates (arrow) arranged in a diffuse and nodular pattern. The white open spaces are entrapped fat cells (H&E, ×200).

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