DIFFICULTY IN DIAGNOSING RETROPERITONEAL FIBROSIS
Rezgui Amel*, Ben Hassine Imen, Karmani Monia, Ben Fredj Fatma and Laouani Chedia
The retroperitoneal fibrosis (RPF) is a rare disease with multiple etiologies. The management of this entity is not standardized. We report a case illustrating the diagnostic difficulties of this disease. A 21 year-old male patient presented with persistent fever and poor general condition without associated signs. There was a biological inflammatory syndrome. A urinary test strip showed the presence of hematuria and proteinuria. The infection inquiry was negative; as well as the immunological tests. A CT scan showed a retroperitoneal mass. The pathological result was consistent with an inflammatory pseudo tumor. Due to an unexplained proteinuria and hematuria renal biopsy was made and showed post-infectious glomerulonephritis. The patient was prescribed immunosuppressive therapy including anti-TNF therapy. After improvement, we noted a resurgence of fever, with biological inflamatory syndrome. There was an increase in the size of the tumor without any mass effect or intra thoracic extension. The surgical resection was undertaken and pathology findings reported a retroperitoneal fibrosis mass surrounding abdominal vessels with a peri lymph node involvement. This case illustrates the diagnostic and therapeutic difficulty of the RPF due to non specific clinical features and points out a differential diagnosis which is the inflammatory pseudo tumor.
Keywords: retroperitoneal fibrosis, inflammatory pseudotumor, diagnosis.
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