A 60-year-old woman with a six-month history of retroperitoneal fibrosis transfers her care to you. She initially presented with severe bilateral flank pain radiating to the abdomen and chest. A computerized tomography (CT) angiogram of the abdomen demonstrated an infrarenal abdominal aortic aneurysm surrounded by a thick inflammatory rind entangling the left renal vein and ureter, resulting in left hydronephrosis and 70% stenosis of the proximal left renal artery.
Explore this issueApril 2019
She underwent percutaneous endovascular repair of the aortic aneurysm and was started on prednisone and mycophenolate mofetil. She subsequently required bilateral ureteral stents and left nephrostomy tube placement. Her course of treatment has been complicated by numerous nephrostomy tube malfunctions requiring repositioning in addition to the anticipated periodic ureteral stent exchanges.
As you review her chart, you note that she has had six inpatient admissions, approximately one per month, since the onset of her symptoms. At this initial visit she is, objectively, doing well. You note that her inflammatory markers—once markedly elevated—have normalized. Additionally, serial abdominal CT scans show significant improvement in periaortic inflammation. She is tolerating her medications and reports that her pain has improved. However, the objective improvement in laboratory data and imaging does not reflect the tearful woman sitting in front of you.| | | Next → | Single Page