Acute renal failure in the setting of bilateral ureteral obstruction secondary to plasmacytoid variant urothelial cell carcinoma

Plasmacytoid urothelial carcinoma (PUC) is an aggressive variant of urothelial cell carcinoma (UCC) that has a tendency for unique presentation at time of diagnosis. We present a 68-year-old male who developed generalized abdominal pain with an incidental finding of acute renal failure secondary to ureteral strictures. He was subsequently diagnosed with PUC. Management of PUC is multifactorial with neoadjuvant chemotherapy followed by radical cystectomy. Despite these invasive treatments, the prognosis is often significantly inferior to typical UCC. This case demonstrates the need for high clinical suspicion in the setting of unpredicted strictures within the abdomen and pelvis.