IgG4-Related Ureteral Stricture

A 38-year-old female had flank pain that did not relate to menstrual period for 2 months. Renal ultrasound revealed mild hydronephrosis. She had normal CBC, BUN/creatinine was 1.06/15 mg/dL, and microscopic hematuria. CT scan is shown (Fig. 1). The RP and URS revealed 3-cm long bilateral distal ureteral stricture with whitish fibrotic mass, which was biopsied by biopsy forceps (Figs. 2, 3). The pathology report indicated lymphoplasmacytic tissue infiltration with fibrosis. Urine PCR for TB was negative. The DJ stents were placed for 6 months and stricture was spontaneously resolved. One year later, she has recurrent stricture. Figure 2The retrograde ureterography demonstrates distal ureteral stricture. View Large Image Figure Viewer Download Hi-res image Figure 3The URS demonstrates a fibrotic mass at both distal ureters. View Large Image Figure Viewer Download Hi-res image