The Southern Medical Journal (SMJ) is the official, peer-reviewed journal of the Southern Medical Association. It has a multidisciplinary and inter-professional focus that covers a broad range of topics relevant to physicians and other healthcare specialists.

SMJ // Article

Letter to the Editor

The Evolving Etiopathogenesis of Retroperitoneal Fibrosis

Authors: Harish V. Iyer, MD, MRCP

Abstract

To the Editor:


I read with interest the case report presented by Barquiel et al.1 They state that the presence of autoantibodies against oxidized low density lipoprotein (LDL) and ceroid in the atherosclerotic plaques are paramount to the pathogenesis of retroperitoneal fibrosis (RF). This is not completely true. In the 1980s and 90s, Mitchinson and Parums proposed the hypothesis that chronic periaortitis (an umbrella term that comprises RF) arose as a result of a local reaction to LDL and ceroid. The role of atherosclerosis in the pathogenesis of RF remains controversial at best and emerging data suggests that CP may be a manifestation of a systemic disease, rather than a local reaction.2 It has been noted that in some patients with CP, the involvement is beyond the abdominal aorta and the iliac arteries, but also includes the thoracic aorta. CP also has some features that are similar to Takayasu arteritis. Patients sometimes present with fever, malaise, and anorexia with elevation of systemic inflammatory markers. All this evidence points to RF as a systemic illness.3

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References

1. Barquiel B, Soto C, Adán L, et al. Paucisymptomatic retroperitoneal fibrosis unmasked soon after a colonoscopy: a prompt resolution. South Med J 2009;102:852.
 
2. Vaglio A, Buzio C. Chronic periaortitis: a spectrum of diseases. Curr Opin Rheumatol 2005;17:34–40.
 
3. Vaglio A, Greco P, Corradi D, et al. Autoimmune aspects of chronic periaortitis. Autoimmun Rev 2006;5:458–464.
 
4. Kasashima S, Zen Y, Kawashima A, et al. Inflammatory abdominal aortic aneurysm: close relationship to IgG4-related periaortitis. Am J Surg Pathol 2008;32:197–204.
 
5. Kasashima S, Zen Y, Kawashima A, et al. A new clinicopathological entity of IgG4-related inflammatory abdominal aortic aneurysm. J Vasc Surg 2009;49:1264–1271; discussion 1271.
 
6. Vaglio A, Salvarani C, Buzio C. Retroperitoneal fibrosis. Lancet 2006;367:241–251.
 
7. Marumo K, Tatsuno S, Noto K. Elevated serum IgG4 may predict sensitivity to steroid therapy in retroperitoneal fibrosis. Int J Urol 2009;16:427.