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Enoxaparin-induced Wunderlich syndrome in a young patient with anti-GAD 65-associated opsoclonus and limbic encephalitis: a rare complication in a rare disease
  1. Saranya B Gomathy1,
  2. Animesh Das2,
  3. Awadh Kishor Pandit2 and
  4. Achal Kumar Srivastava2
  1. 1Department of Neurology, Neurosciences Centre, All India Institute of Medical Sciences, Delhi, India
  2. 2Neurology, All India Institute of Medical Sciences, New Delhi, India
  1. Correspondence to Dr Animesh Das; animeshdas05{at}


Wunderlich syndrome is a rare condition characterised by acute spontaneous non-traumatic renal haemorrhage into the subcapsular and perirenal spaces. Our case of anti-GAD65-associated autoimmune encephalitis (AE), aged 30 years, developed this complication following use of enoxaparin and was managed by selective glue embolisation of subsegmental branches of right renal cortical arteries. Our case had opsoclonus as one of the clinical manifestations, which has till now been described in only two patients of this AE. This patient received all forms of induction therapies (steroids, plasmapheresis, intravenous immunoglobulin and rituximab) following which she had good improvement in her clinical condition. The good response to immunotherapy is also a point of discussion as this has been rarely associated with anti-GAD65 AE.

  • neurology (drugs and medicines)
  • interventional radiology

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  • Contributors SBG managed the patient. AD wrote the manuscript. AKP and AKS critically reviewed the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.