Al. Crişan 1, Emilia Nicoară 1, Ruxandra Laza 1
1 “Victor Babeş” University of Medicine and Farmacy, 2nd Clinic of Infectious Diseases, Timişoara
Abstract
Because of its multiple causes, prolonged febrile syndrome often represents a real challenge. Clinical experience divides the causes of this syndrome into: infections (30-40%), neoplasia (10-30%), autoimmune diseases (9-15%), various other causes (15-20%), while 7-10% are of unknown origin. The case we report belongs to other causes group and stands out because it is a new entity among the causes identified in the past: hyperthyroidism, Addison’s disease, Crohn disease, sarcoidosis, atrium myxoma, fever caused by drugs, pulmonary embolism etc. We present the case of a 52 year-old male patient with prolonged febrile syndrome and lumbar pain. Th e laboratory studies revealed nonspecific inflammatory syndrome and high BUN and serum creatinine levels. Th e abdominal ultrasound found a retroperitoneal mass and right hydronephrosis, while the computed tomography scan showed retroperitoneal fi brosis and identifi ed the cause of the hydronephrosis: the right ureter was included in the fi brous process. Alaparotomy was performed and revealed the retroperitoneal fi brosis localized in front of the lower part of the aorta and cava, under the kidneys, all the way to the emergence of the iliac vessels. The fibrous process involved both ureters. Th e histological exam confi rmed the presence of a chronic, noninfectious fi brosis. Early diagnosis followed by surgical intervention prevented the occurrence of obstructive renal failure. Th e long-term prognosis depends on whether the fi brosis is a primary or a secondary process and whether it is associated with another immune pathology.