A 45-year-old woman with a history of lumbosacro- and hypogastric pain for months had consulted several doctors and underwent numerous tests without reaching a definitive diagnosis.
Pain was not associated with symptoms or signs characteristic of a specific collagen-vascular disease and autoimmunity tests were negative.
Subsequently, an abdominal scan showed a retroperitoneal mass and left hydronephrosis that led to suspicion of lymphoma.
We tried to install a ureteral double-J stent endoscopically, which was unsuccessful and a nephrostomy was performed.
Months later, a puncture biopsy under vision was performed with a retroperito-neal mass scanner.
Histology showed an infiltrated lymphotiocytic tissue accompanied by fibrosis and the presence of some germinal centers, with a reactive morphological pattern.
Immunohistochemistry showed positive staining for cD3, cD4 and bcl2, absence of a restriction pattern for lambda and kappa and negative staining for cD30.
No staining was performed to determine the presence of IgG4.
The analysis of the sample by 3 pathologists concluded that there were elements characteristic of retroperitoneal fibrosis (RPF), diagnosing Ormond disease.
One month later, partial resection of the retroperitoneal tissue was performed. A ureteral catheter was installed intraoperatively.
A new scanner performed one month after the operation showed a tissue that was enhanced with the radiological contrast medium, which began under the left renal vein encompassing the aorta and inferior vena cava and extended to the iliac vessels.
The left kidney showed less elimination of the means of contrast than the right kidney and the excretory apparatus was relaxed to the mid ureter through the physical examination of this poorly defined and sensitive mass.
Laboratory tests revealed anemia (hemoglobin 10.9 g/dl), elevated inflammatory parameters (HSV 47 mm/hour, c-reactive protein 21.3 mg/L, rouleaux ++000), normal thrombocytosis (468.
The patient ingested from the previous year and daily, tramadol, paracetamol and alprazolam for the relief of symptoms of her illness. At directed interview she recognized to ingest by self-prescription a medication associated with caffeine daily use of ergochit
At the follow-up of the following month, the pain had decreased significantly, the ureteral appetite had improved and there was complete absence of left kidney anemia and signs of inflammation in laboratory tests. Two months after the beginning of the treatment, the abdominal pain had decreased.
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In the following months, the dose of steroids was paulatinally reduced until reaching a dosage of steroid manatee 5 mg/day of prednisone, maintaining colchicine at 1 mg/day.
One year after starting treatment, the patient was asymptomatic, a scanner showed little periaortic tissue and laboratory tests showed no elevation of inflammatory parameters.
Therapy with colchicine 1 mg/day and prednisone 5 mg/day was continued without symptoms of recurrence of the disease in the 29 months of follow-up.
