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Almond Leung1, Haitham M Elasir2, Karim M Mahawish3
1geriatric and stroke medicine, MidCentral DHB, Palmerston North, New Zealand.
Abstract:
Idiopathic retroperitoneal fibrosis is a rare disease. Symptoms include constitutional symptoms and abdominal/flank pain. Causes of retroperitoneal fibrosis include non-infectious and infectious etiologies. Of the infectious etiologies, tuberculous aortitis is an important differential as it is associated with a high mortality rate. We present a case of a 59-year-old man with a retroperitoneal periaortic mass initially diagnosed as tuberculous aortitis. However following biopsy, the diagnosis was later amended to idiopathic retroperitoneal fibrosis with latent tuberculosis. He was successfully treated with prednisone and methotrexate.
Insights
Idiopathic retroperitoneal fibrosis, a rare condition, can mimic tuberculous aortitis. This case highlights successful treatment of idiopathic retroperitoneal fibrosis with latent tuberculosis using prednisone and methotrexate.
Area of Science:
- Nephrology
- Infectious Diseases
- Cardiovascular Medicine
Background:
- Idiopathic retroperitoneal fibrosis (IRPF) is a rare condition characterized by inflammation and fibrosis in the retroperitoneum.
- It can present with constitutional symptoms and abdominal or flank pain, mimicking other serious conditions.
- Infectious etiologies, particularly tuberculous aortitis, are critical differentials due to their high mortality.
Observation:
- A 59-year-old man presented with a retroperitoneal periaortic mass.
- Initial diagnosis suggested tuberculous aortitis.
- Biopsy results revised the diagnosis to idiopathic retroperitoneal fibrosis with co-existing latent tuberculosis.
Findings:
- Idiopathic retroperitoneal fibrosis can be mistaken for infectious causes like tuberculous aortitis.
- Accurate diagnosis through biopsy is crucial for appropriate management.
- Latent tuberculosis may coexist with idiopathic retroperitoneal fibrosis.
Implications:
- This case underscores the importance of considering idiopathic retroperitoneal fibrosis in the differential diagnosis of retroperitoneal masses.
- Timely and accurate diagnosis prevents unnecessary or incorrect treatments for conditions like tuberculous aortitis.
- Successful management with immunosuppressants (prednisone) and disease-modifying agents (methotrexate) in IRPF with latent TB offers a therapeutic pathway.
