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Retroperitoneal Fibrosis and Immunoglobulin G4

      To the Editor:
      The publication “IgG4 isolated retroperitoneal fibrosis and aneurysmal periaortitis” is interesting.
      • Sanchez-Alvarez C.
      • Bowman A.W.
      • Menke D.M.
      • Wang B.
      IgG7 isolated retroperitoneal fibrosis and aneurysmal periaortitis.
      In the treatment, the authors forgot to mention tamoxifen as an alternative therapy in patients who cannot take glucocorticoids. Positive responses to tamoxifen alone
      • Brandt A.S.
      • Kamper L.
      • Kukuk S.
      • Haage P.
      • Roth S.
      Tamoxifen monotherapy in the treatment of retroperitoneal fibrosis.
      or in combination with glucocorticoids have been reported in patients with retroperitoneal fibrosis.
      • Costanzi S.
      • Zoli A.
      • Ferraro P.M.
      • Danza F.M.
      • Ferraccioli G.F.
      A paraneoplastic retroperitoneal fibrosis resistant to corticosteroids treated with tamoxifen.
      A prospective study
      • Van Bommel E.F.
      • Pelkmans L.G.
      • Van Damme H.
      • Hendriksz T.R.
      Long-term safety and efficacy of a tamoxifen-based treatment strategy for idiopathic retroperitoneal fibrosis.
      involving 55 patients with retroperitoneal fibrosis described the long-term course and outcomes of patient treated with tamoxifen monotherapy: 71% and 85% of patients showed mass regression at 4 months and 8 months of treatment, respectively, and 68% of patients showed recurrence-free survival after posttreatement follow-up of 21 months. Tamoxifen is a safe therapeutic option in retroperitoneal fibrosis, and this should be added to the report.

      References

        • Sanchez-Alvarez C.
        • Bowman A.W.
        • Menke D.M.
        • Wang B.
        IgG7 isolated retroperitoneal fibrosis and aneurysmal periaortitis.
        Am J Med. 2017; 130: e521-e524
        • Brandt A.S.
        • Kamper L.
        • Kukuk S.
        • Haage P.
        • Roth S.
        Tamoxifen monotherapy in the treatment of retroperitoneal fibrosis.
        Urol Int. 2014; 93: 320-325
        • Costanzi S.
        • Zoli A.
        • Ferraro P.M.
        • Danza F.M.
        • Ferraccioli G.F.
        A paraneoplastic retroperitoneal fibrosis resistant to corticosteroids treated with tamoxifen.
        Clin Nephrol. 2008; 70: 172-175
        • Van Bommel E.F.
        • Pelkmans L.G.
        • Van Damme H.
        • Hendriksz T.R.
        Long-term safety and efficacy of a tamoxifen-based treatment strategy for idiopathic retroperitoneal fibrosis.
        Eur J Intern Med. 2013; 24: 444-450