Abstract

Title of the article: Immuno-globulin G4 related disease associated retroperitoneal fibrosis: A rare cause of chronic back ache. Introduction: Retroperitoneal fibrosis is an uncommon presentation of IgG4 – Related Disease, often presenting with non-specific symptoms leading to delayed diagnosis and management. Case report: This case report describes a 67-year-old female who presented to the emergency department with complaints of gradually worsening back ache in the last 3 months; associated with urinary hesitancy and fever with chills; not resolving with antibiotics and analgesics. Contrast Enhanced Computed Tomography abdomen was suggestive of left pyelonephritis and retro-peritoneal inflammatory fibrosis. IgG4 sub class level of 1.71 (Reference range: 0.1 – 1.2). The patient was started on glucocorticoid therapy resulting in rapid symptoms resolution. Maintenance therapy with Tab. Mycophenolate mofetil 500mg once daily was started to prevent relapse. Conclusion: When lower back pain is present with symptoms like abdominal pain and obstructive urinary tract symptoms retroperitoneal fibrosis should be considered in the differential diagnosis. Recognizing the association is crucial for initiating appropriate therapy to prevent progression. KEY MESSAGE • When lower back pain is present with symptoms like abdominal pain or obstructive urologic symptoms in the Emergency Department, retroperitoneal fibrosis should be considered in the differential diagnosis, as gglucocorticoid therapy alone usually results in rapid symptoms resolution. • Retroperitoneal fibrosis has a relatively common association with IgG4 related disease – a rare fibro-inflammatory disease.

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