J Rheum Dis.  2015 Apr;22(2):123-126. 10.4078/jrd.2015.22.2.123.

Idiopathic Retroperitoneal Fibrosis Associated with Rheumatoid Arthritis in a Patient with Concomitant Chronic B Viral Hepatitis

• Lee HS
• Park JE
• Nam SW
• Shim KY
• Kang T

• KMID: 2222916
• DOI: http://doi.org/10.4078/jrd.2015.22.2.123

Abstract

Retroperitoneal fibrosis (RPF) is a rare, progressive disease characterized by chronic non specific inflammation of the retroperitoneum. Although the pathogenesis of idiopathic retroperitoneal fibrosis (IRF) remains unclear, IRF has been reported in association with autoimmune disorders. However, few cases of IRF associated with rheumatoid arthritis (RA) have been reported. We experienced a rare case of IRF in a patient with RA and chronic B viral hepatitis. A 39-year-old Korean man with RA and hepatitis B was referred to our hospital due to left hydronephrosis. An abdominal computed tomography (CT) scan and magnetic resonance imaging (MRI) showed a diffuse infiltrating retroperitoneal mass around the abdominal aorta and left ureter. The patient underwent intraureteral stent insertion and was treated with corticosteroid. Three months later, the follow up abdominal CT showed that the retroperitoneal mass had decreased in size. Herein, we report the first case of coexistent IRF, RA, and chronic B viral hepatitis with a literature review.

Keyword

Retroperitoneal fibrosis; Rheumatoid arthritis; Chronic Hepatitis B; Steroid

MeSH Terms

Adult
Aorta, Abdominal
Arthritis, Rheumatoid*
Follow-Up Studies
Hepatitis B
Hepatitis B, Chronic
Hepatitis*
Humans
Hydronephrosis
Inflammation
Magnetic Resonance Imaging
Retroperitoneal Fibrosis*
Stents
Tomography, X-Ray Computed
Ureter

Figure

• 

  Figure 1. (A) Abdominal computed tomography shows a diffuse infiltrating soft tissue mass (about 5.0×2.5×10.3 cm sized) extending from the lower abdominal aorta to the level of the iliac bifurcation and left ureteral obstruction (arrow). (B) Atrophic change on left kidney (arrowhead).

• 

  Figure 2. (A) The lesion reveals a fibrous proliferation with broad anatomizing bands of collagen. Occasionally lymphoid aggregates are noted (arrow) (H&E, ×40). (B) Fibrous proliferation with sclerotic collagen bands (H&E, ×200).

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  Figure 3. The retroperitoneal mass was decreased at the follow-up abdominal computed tomography (arrow).

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