Case Reports
22 March 2024
Vol. 76 No. 1 (2024)
https://doi.org/10.4081/reumatismo.2024.1669

Wunderlich syndrome as a rare complication of polyarteritis nodosa: a case report

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Wunderlich syndrome, polyarteritis nodosa, spontaneous perirenal hematoma, retroperitoneal hemorrhage, computed tomography
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Authors

D. Oliveira
danielasoff@gmail.com
https://orcid.org/0000-0001-9734-3162
Rheumatology Department, São João University Hospital Center, Porto; Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Portugal.
A. Martins
https://orcid.org/0000-0001-7581-4074
Rheumatology Department, São João University Hospital Center, Porto, Portugal.
F. Martins
https://orcid.org/0000-0002-9742-2677
Rheumatology Department, University Hospital Center of the Algarve, Faro, Portugal.
M. Rato
Rheumatology Department, São João University Hospital Center, Porto; Department of Medicine, Faculty of Medicine, University of Porto, Portugal.
F. Pinheiro
https://orcid.org/0000-0002-3162-9018
Rheumatology Department, São João University Hospital Center, Porto, Portugal.
D. Fonseca
Rheumatology Department, Vila Nova de Gaia/Espinho Hospital Center, Gaia, Portugal.
C. Vaz
https://orcid.org/0000-0002-5433-2874
Rheumatology Department, São João University Hospital Center, Porto; Center for Health Technology and Services Research, Faculty of Medicine, University of Porto; Department of Medicine, Faculty of Medicine, University of Porto, Portugal.
E. Mariz
Rheumatology Department, São João University Hospital Center, Porto; Department of Medicine, Faculty of Medicine, University of Porto, Portugal.
L. Costa
https://orcid.org/0000-0002-5817-5394
Rheumatology Department, São João University Hospital Center, Porto, Portugal.

Spontaneous subcapsular and perirenal hemorrhage, known as Wunderlich syndrome (WS), is a rare clinical manifestation of polyarteritis nodosa (PAN). We report a case of a 48-year-old male with a history of recurrent episodes of leg muscle tenderness and dysesthesia, bilateral flank pain, painful nodular skin lesions in the lower limbs, weight loss, and difficult-to-control arterial hypertension. The abdominopelvic computed tomography angiography showed a large left perirenal hematoma, leading to the patient’s admission to the intensive care unit. After the exclusion of infectious or neoplastic foci, the patient was diagnosed with PAN and started intravenous methylprednisolone pulses with a good response. Since WS is a rare initial clinical manifestation of PAN, an early diagnosis and aggressive treatment will significantly improve clinical outcomes.

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Wunderlich syndrome as a rare complication of polyarteritis nodosa: a case report. (2024). Reumatismo, 76(1). https://doi.org/10.4081/reumatismo.2024.1669
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