Late-onset damage from occupational asbestos exposure: case report

Retroperitoneal fibrosis (RPF), also known as Ormond's disease, is a rare condition characterized by fibrosis in the retroperitoneal space, affecting structures such as the kidneys, ureters, subrenal portion of the abdominal aorta, and the inferior vena cava. While idiopathic RPF is the most common form, it is crucial to rule out secondary causes, which may include certain medications, neoplasms, infections, surgical interventions, or environmental exposures. Prolonged occupational exposure to asbestos is recognized as a rare yet significant cause of RPF.

We present the case of a 64-year-old male patient from Casablanca with no notable medical history who reported right low back pain without accompanying fever and exhibited signs of a deteriorating general condition. Clinical examination revealed tenderness upon palpation of the right flank and a left thyroid nodule. Ultimately, a diagnosis of RPF secondary to prolonged occupational asbestos exposure was established. The patient underwent the insertion of a right JJ stent and received combined corticosteroid therapy.

RPF is a chronic condition with management protocols that remain largely undefined, particularly for cases secondary to prolonged occupational asbestos exposure. In benign forms of RPF, corticosteroid therapy serves as the cornerstone of treatment. However, clinicians often find it necessary to incorporate immunosuppressants to prevent frequent relapses associated with tapering or discontinuing corticosteroid therapy. Our initial experience with azathioprine (AZA) has shown promising results.