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

Abstract

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 Her mental status recovered successfully, and she was withdrawn from short-term hemodialysis.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.

Spontaneous perirenal hemorrhage (Wunderlich syndrome) in the fetus: a case report

“…The factors contributing to WS include renal tumors, angiomyolipoma, renal arteriovenous malformation, hydronephrosis, tuberous sclerosis complex, and so on [ 1 – 3 , 5 ]. Literature research indicated that renal tumors were the most common cause of WS, and hydronephrosis was an uncommon cause [ 1 , 3 , 6 ].…”

Rare case of lupus enteritis presenting as colorectum involvement: A case report and review of literature

“…Arteritis and venulitis of the colon and rectum may be the result of aggravation of SLE. Vasculitis is the most common cause of mucosal damage[ 22 ].The deposition of immune complexes in the vascular endothelium, arterial muscular and elastic elements by circulation autoantibodies may lead to leukocytoclastic vasculitis[ 10 , 24 , 28 ], thrombosis and vasculitis of vessels supplying of the intestine vessels walls and the target organ[ 8 , 29 ]. The involvement of the renal and intestinal small vessels may be the major cause due to the autoimmune disorder and active SLE, especially when other causes have been excluded[ 30 ].…”

Retroperitoneal anatomy with the aid of pathologic fluid: An imaging pictorial review

“…[ 24 ] Rarely, spontaneous perirenal hemorrhage may occur. [ 25 , 26 ] Urine leaks or urinomas occur following abdominal injury and result from disrupting the urinary collecting system. [ 27 ] Urine leaks result from 1% to 7% of renal injuries and over a quarter of patients with grade four renal injuries.…”