Chronic periaortitis: A clinical approach

Gianfreda, Davide; Superchi, E; Peyronel, Francesco; Mazzariol, Martina; Vaglio, Augusto

doi:10.1016/j.revmed.2022.11.009

Cited by 6 publications

(5 citation statements)

References 55 publications

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“…Histology of the exanthema revealed infiltration by plasma cells (no increased IgG4 positivity) and eosinophils without evidence of a sarcoid-like reaction. His current medications were levothyroxine, amlodipine, and valsartan, which are not known to induce periaortitis [6]. Laboratory workup revealed an elevated C-reactive protein (CRP) level of 40 mg/l (normal: <5 mg/l), an elevated erythrocyte sedimentation rate (ESR) of 81 mm/hour (normal: 0-20 mm/ hour), increased serum IgG4 concentration of 3.32 g/l (normal: 0.08-1.4 g/l), and mildly reduced kidney function (creatinine = 110 µmol/l [normal: <104 µmol/l]).…”

Section: Case Reportmentioning

confidence: 99%

Successful treatment of immune checkpoint inhibitor-related periaortitis

Bührer,

Alberts,

Christ

et al. 2024

Swiss Med Wkly

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We report a 64-year-old patient with melanoma receiving ipilimumab and nivolumab therapy who presented with a periaortic soft tissue mass around the abdominal aorta on restaging fluorodeoxyglucose positron emission tomography/computed tomography imaging. Clinical, laboratory, and radiologic findings resulted in a diagnosis of immune checkpoint inhibitor-related periaortitis. Periaortitis is a rare disease presenting with fibro-inflammatory tissue around the aorta and may lead to serious complications. Immune checkpoint inhibitors were discontinued, and the patient was treated with glucocorticoids, leading to a complete resolution of the periaortitis. To our knowledge, this is only the third reported case of immune checkpoint inhibitor-related periaortitis.

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Section: Case Reportmentioning

confidence: 99%

Successful treatment of immune checkpoint inhibitor-related periaortitis

Bührer,

Alberts,

Christ

et al. 2024

Swiss Med Wkly

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“…Contrast enhancement, both in CT and MRI, also correlates with disease activity. However, fluorodeoxyglucose-positron emission tomography (FDG-PET) remains the gold standard for assessing disease activity at diagnosis and during follow-up, proving to be even more sensitive and specific than the common indices of serum inflammation [54]. Imaging (associated with specific laboratory investigations and clinical picture of the overall patient) also plays a fundamental role in the differential diagnosis with other pathologies (autoimmune, infectious, neoplastic disease), which must be ruled out [48].…”

Section: Retroperitoneal Fibrosismentioning

confidence: 99%

“…In around 30-50% of cases, it is possible to find histological matrix composed of storiform fibrosis and a cellular component consisting of an intense infiltration of IgG4positive plasma cells with a high IgG4/IgG ratio, compatible with IgG4-RD. RPF can found in the context of IgG4-related disease (see section on IgG4-related kidney disease) with which it shares epidemiology, etiopathogenesis, prognosis, and response to treatment with high doses of steroids, immunosuppressants, and monoclonal antibodies [54].…”

Section: Retroperitoneal Fibrosismentioning

confidence: 99%

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Renal and Urinary Tract Involvement in Fibrosclerosing or Fibroinflammatory Diseases: A Narrative Review

Rossi,

Pala,

Gianfreda

2023

Rheumato

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Fibroinflammatory diseases are a group of rare pathologies in which the hallmark is the exuberant deposition of fibrotic tissue and inflammatory cellular infiltrates, characteristic of the specific disease. A sclerotic mass develops within soft tissues and/or organs, damaging and replacing them, with effects ranging from asymptomatic to life-threatening clinical manifestations. The kidneys and urinary tract can be involved in some of these diseases, which can lead to acute kidney injury, chronic kidney disease, and even end-stage kidney disease. IgG4-related disease, retroperitoneal fibrosis, and Erdheim–Chester disease are the three fibroinflammatory disorders that can involve the kidneys. Only a timely and accurate collection of clinical, radiological, metabolic, laboratory, and histological data allows prompt diagnosis and targeted treatment of these pathologies, allowing the stoppage of the evolution of renal and systemic manifestations, which can lead to complete remission. The epidemiology, clinical and histological features, and management of these conditions are herein described in a narrative fashion.

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“…However, other immunosuppressive drugs can be used in combination if there is an inadequate response to GCs or side effects. In patients with hydronephrosis or vascular com pression, interventional methods such as nephrostomy and/or dou bleJ ureteral stenting, vascular stenting and surgical methods such as ureterolysis or appropriate surgical techniques for the compres sive mass may be required [11,12].…”

Section: Introductionmentioning

confidence: 99%

Is a Biopsy Required to Classify Patients with Idiopathic Retroperitoneal Fibrosis as IgG4-RPF or Non-IgG4-RPF?

Misirci,

Ekin,

Coskun

et al. 2024

Aktuelle Rheumatologie

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Objective Our aim was to group cases of idiopathic retroperitoneal fibrosis (IRPF) into those associated with immunoglobulin (Ig) G4-related disease (IgG4-RD) (IgG4-RPF) and those not associated with IgG4-RD (non-IgG4-RPF) and to compare the clinical presentation, laboratory findings, imaging, and treatment methods. Methods A total of 46 patients were included in the study. According to the assessment by two experienced rheumatologists and the IgG4-RPF classification criteria published by the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) in 2019, 11 patients who were admitted as IgG4-RPF were included in the IgG4-RPF group and 35 patients who were not admitted as IgG4-RPF were included in the non-IgG4-RPF group. The clinical and demographic characteristics, affected sites, laboratory results and treatments were retrospectively evaluated and compared. Results The mean age of our patients was 50.69 (±11.33) in the non-IgG4-RPF group and 55.36 (±7.80) in the IgG4-RPF group and was similar in both groups (p=0.340). The male gender dominated in both groups. Although there was no significant difference between the groups in terms of acute renal failure (p=0.074), this was more frequent in the IgG4-RPF group (81.82%). An increased IgG4 concentration was found in about half (n=6, 54.55%) of the patients in the IgG4-RPF group, while this was present in only 5.71% (n=2) of the patients in the non-IgG4-RPF group (p=0.001). The most commonly used diagnostic imaging modality was computed tomography. Biopsy was performed in almost all patients (n=10, 90.91%) in the IgG4-RPF group and 11 (31.43%) in the non-IgG4-RPF group (p<0.001). Drug treatment alone and drug treatment in combination with interventional treatment were the most commonly used treatment modalities in the non-IgG4-RPF group (n=12, 34.29% for both). In the IgG4-RPF group, the combination of medical and interventional treatment was the most commonly used treatment modality (n=5, 45.45%). No significant difference was found between the two groups in the assessment of treatment success (p>0.05). Conclusion IRPF can present with similar clinical and imaging findings in IgG4-RPF and non-IgG4-RPF groups. Since a similar treatment success can be achieved in both groups with similar therapeutic agents, we believe that a biopsy is not necessary in patients with an uncertain diagnosis of IRPF.

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Chronic periaortitis: A clinical approach

Cited by 6 publications

References 55 publications

Successful treatment of immune checkpoint inhibitor-related periaortitis

Successful treatment of immune checkpoint inhibitor-related periaortitis

Renal and Urinary Tract Involvement in Fibrosclerosing or Fibroinflammatory Diseases: A Narrative Review

Is a Biopsy Required to Classify Patients with Idiopathic Retroperitoneal Fibrosis as IgG4-RPF or Non-IgG4-RPF?

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