Enoxaparin-induced Wunderlich syndrome in a young patient with anti-GAD 65-associated opsoclonus and limbic encephalitis: a rare complication in a rare disease

Abstract

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.

Computed Tomography Findings in Wunderlich Syndrome

“…The literature contains studies that are mostly in the form of case reports indicating coagulation disorders as a rare cause of WS. 24,25 In addition, there are other case reports showing that oral anticoagulant therapy, which is widely used today, can cause WS. 26 It is known that patients with chronic kidney disease who undergo haemodialysis have a predisposition to platelet dysfunction and bleeding secondary to endothelial abnormalities.…”