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General practice and family medicine
Wunderlich syndrome in a patient with pyelonephritis
  1. Joshua Chin Howe Chia1,
  2. Chiara Jiamin Chong1,
  3. Yan Rong Yong2 and
  4. Poh Yong Tan1
  1. 1Department of Internal Medicine, Singapore General Hospital, Singapore
  2. 2Department of Radiology, Changi General Hospital, Singapore
  1. Correspondence to Dr Joshua Chin Howe Chia; joshua.chia{at}mohh.com.sg

Abstract

An elderly female patient with left pyelonephritis developed worsening left flank pain, hypotension and a drop in haemoglobin (Hb) from 97 g/L to 67g/L on the third day of her admission. There was no recent trauma, history of coagulopathy or risk factors for renal malignancy or vascular disease.

A contrasted CT scan of the kidneys revealed a 3.8 cm left renal subcapsular haematoma with no active contrast extravasation. Her atraumatic subcapsular haematoma fulfils two out of three clinical features of Lenk’s triad (acute flank pain, hypovolaemic shock), suggestive of Wunderlich syndrome. Urine and blood cultures grew Klebsiella pneumoniae and she was managed conservatively with culture-directed antibiotics, fluids and blood products.

Wunderlich syndrome is a rare complication of pyelonephritis and should be considered in patients with pyelonephritis who develop acute severe flank pain, Hb drop and haemodynamic instability. Appropriate medical and surgical therapies need to be instituted early to ensure good outcomes.

  • Urinary tract infections
  • Urinary tract infections

https://doi.org/10.1136/bcr-2023-257325

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    Footnotes

    • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: JCHC, CJC, YRY and PYT. The following authors gave final approval of the manuscript: JCHC, CJC, YRY and PYT.

    • 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.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

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