Spontaneous perirenal hemorrhage in systemic lupus erythematosus: a rare case report and literature review

Background Spontaneous perirenal hemorrhage is relatively uncommon but may be life-threatening. There are some challenges in early diagnosis due to the lack of specific presentations. Case presentation We report a case of spontaneous perirenal hemorrhage in a newly diagnosed systemic lupus erythematosus patient who initially presented with non-specific flank pain. Weakness and unstable vital signs were noted on admission. Abdominal ultrasonography and computed tomography revealed a sizable perirenal hematoma over the left retroperitoneal cavity. Renal arteriography identified active extravasation of contrast media from a distant branch of the left renal artery, and selective embolization effectively obliterated the bleeding spot. After cessation of bleeding, the patient received intensive immunosuppressive therapy for acute kidney injury and encephalopathy due to lupus. Her mental status recovered successfully, and she was withdrawn from short-term hemodialysis. Conclusions Spontaneous perirenal hemorrhage in the condition of systemic lupus erythematosus was a rare clinical entity with life-threatening potential. Early accurate diagnosis of spontaneous renal hemorrhage requires both detailed clinical examination and radiologic studies. Interventional embolization is essential and effective for both diagnosis and treatment. A high index of suspicion is necessary to avoid missing this potentially fatal syndrome, especially in patients with an increased risk of bleeding.

A rare case of spontaneous perirenal hemorrhage - Wunderlich syndrome

Introduction. Spontaneous perirenal hemorrhage or Wunderlich syndrome represents a rare entity in the urological settings. The vast majority of the causes are represented by angiomyolipoma and renal cell carcinoma. In other cases, the vascular abnormalities, polycystic kidneys, polyarthritis nodosa or pyelonephritis could represent the cause of perirenal bleeding. The treatment depends on clinical parameters at the presentation as on the presence of eventual renal malignancies. Our goal was to present a rare case of a healthy men who presented the idiopathic Wunderlich syndrome. Case outline. We present the case of 50 years old patients with spontaneous perirenal hemorrhage which was not due to any defined cause even after sixth months follow-up. Conclusion. In some rare cases of perirenal bleeding the cause cannot be defined at the presentation, even with today?s very developed radiologic imaging and methods. Thus, it is important to be aware of the fact that in those cases, the longer follow up is needed, knowing that the presence of perirenal hematoma can always obscure the real diagnosis. Sometimes, even in the cases where the proper follow-up has been done, the real cause of the bleeding remains unknown.