Wegener's granulomatosis presenting as lower back pain with prostatitis and ureteral obstruction

A 65-year-old man presented with progressive, severe lower back pain, obstructive uropathy, and weight loss. Examination revealed a large, firm prostate, and laboratory studies included an elevated creatinine, erythrocyte sedimentation rate, and prostate specific antigen level. A chest radiograph displayed multiple nodules and a renal ultrasound demonstrated unilateral hydronephrosis. Biopsies of both the prostate and the lung showed necrotizing granulomas consistent with Wegener's granulomatosis, and the patient had positive cytoplasmic antineutrophil cytoplasmic antibodies. He was treated with cyclophosphamide with resolution of all signs and symptoms, and clearing of his radiograph. Our case represents the rare occurrence of Wegener's granulomatosis presenting as prostatitis and ureteral obstruction.