WEGENERS GRANULOMATOSIS PRESENTING AS LOWER BACK PAIN WITH PROSTATITIS AND URETERAL OBSTRUCTION

A 65-year-old man presented with progressive, severe lower back pain, obstructive uropathy, and weight loss. Examination revealed a large, f irm prostate, and laboratory studies included an elevated creatinine, erythrocyte sedimentation rate, and prostate specific antigen level. A chest radiograph displayed multiple nodules and a renal ultrasound de monstrated unilateral hydronephrosis. Biopsies of both the prostate an d the lung showed necrotizing granulomas consistent with Wegener's gra nulomatosis, and the patient had positive cytoplasmic antineutrophil c ytoplasmic antibodies. He was treated with cyclophosphamide with resol ution of all signs and symptoms, and clearing of his radiograph. Our c ase represents the rare occurrence of Wegener's granulomatosis present ing as prostatitis and ureteral obstruction.