Headache and a syndrome of bilateral hydronephrosis.

A 33-year-old woman presented in January 1980 with symptoms of persisting severe pain in the lower abdomen and weight loss. During menstruation there was worsening of the pain, nausea and vomiting. She had periods of headache, which impressed as a vascular headache. Seven years previously she consulted an internist because of general malaise. He found no cause; however the erythrocyte sedimentation rate (ESR) was 73 mm (1 h). During follow-up the ESR remained elevated. By physical examination we found a blood pressure of 180u125 mmHg, but no other abnormalities. The ESR was 92 mm, renal and liver function tests were normal, serum IgG was 17.8 gul (normal 6.8–11.2), serum IgA and IgM were normal. ANA and cryoglobulins were not found. Urinalysis showed no abnormalities, there was no proteinuria. By ultrasound there was a hydronephrosis on both sides. A CT scan of the abdomen showed enlarged lymph nodes in the vicinity of both kidneys and a solid process in the pelvis. The late phase of an angiography (Figure 1) showed proximal ureteral dilation caused by impression of a more distal process. An operation was performed.