J Rheum Dis.  2015 Dec;22(6):391-394. 10.4078/jrd.2015.22.6.391.

Retroperitoneal Fibrosis in a Patient with Rheumatoid Arthritis

• Oh YJ
• Lee WS
• Kang MH
• Hwang JH
• Yoo WH

• KMID: 2222815
• DOI: http://doi.org/10.4078/jrd.2015.22.6.391

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.

Keyword

Retroperitoneal fibrosis; Rheumatoid arthritis

MeSH Terms

Adalimumab
Abdominal Pain
Arthritis, Rheumatoid*
Biopsy
Diagnosis
Dysuria
Endothelial Cells
Fatigue
Fibroblasts
Granuloma
Humans
Iliac Artery
Low Back Pain
Lymphocytes
Macrophages
Male
Methotrexate
Middle Aged
Retroperitoneal Fibrosis*
Ureter
Methotrexate

Figure

• 

  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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