BACKGROUND: Inflammatory pseudotumor is a rare benign cause of lymphadenopathy previously reported in several anatomic locations that can simulate malignant neoplasm. CASE: A postmenopausal woman presented with abdominal pain, generalized malaise, leukocytosis, and intermittent fevers up to 102°F. A 5-day course of antibiotics was given with persistence of symptoms. Computed tomography of the abdomen and pelvis demonstrated an ill-defined, retroperitoneal soft-tissue density, and lymphadenopathy. She underwent an exploratory laparotomy, total abdominal hysterectomy, bilateral salpingo-oophorectomy, and unilateral pelvic and paraaortic lymphadenotomy. Histologic examination revealed inflammatory pseudotumor of the lymph nodes, with immunohistochemical studies demonstrating actin-positive myofibroblastic cells. Four months after surgery, the patient remains asymptomatic without evidence of disease. CONCLUSION: Inflammatory pseudotumor of the pelvic lymph nodes is a rare entity and should be included in the differential diagnosis of patients with persistent fever and lymphadenopathy. © 2006 by The American College of Obstetricians and Gynecologists. Published by Lippincott Williams & Wilkins.