Effectiveness of Colchicine Therapy in 4 Cases of Retroperitoneal Fibrosis Associated with Autoinflammatory Diseases

Abstract

To the Editor: Retroperitoneal fibrosis (RPF) is a fibroinflammatory process affecting the retroperitoneal structures. There are no guidelines for its diagnosis or therapy. We describe 4 cases of RPF associated with autoinflammatory diseases, in which treatment with colchicine allowed RPF regression. RPF is an uncommon disease, with unclear pathogenesis. Systemic manifestations (fever, anorexia, weight loss), often associated with local symptoms (flank pain, leg edema, abdominal discomfort), are related to the entrapment of retroperitoneal structures by the fibrotic plaques. Initial therapy aims at restoring the function of the affected organs with the application of ureteral stents, followed by immunosuppressive therapy. Sometimes, ureteral replacement or kidney autotransplant may be necessary1. Colchicine, a tricyclic alkaloid, interferes with microtubule formation, altering mitosis and inhibiting many steps in the inflammatory process. It reduces adhesion of neutrophils to endothelium, inhibiting neutrophil migration, and blocks the in vitro release of fibronectin from alveolar macrophages2,3. It is approved by the US Food and … Address correspondence to Dr. R. Manna, Department of Internal Medicine, Catholic University, largo A. Gemelli 8, 00168 Rome, Italy. E-mail: rmanna{at}rm.unicatt.it