https://doi.org/10.4081/reumatismo.2024.1669
Wunderlich syndrome as a rare complication of polyarteritis nodosa: a case report
Submitted: 23 October 2023
Accepted: 2 January 2024
Published: 22 March 2024
Accepted: 2 January 2024
Abstract Views: 463
PDF: 316
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
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.
Jennette JC, Falk RJ, Bacon PA, Basu N, Cid MC, Ferrario F, et al. 2012 revised International Chapel Hill Consensus Conference nomenclature of vasculitides. Arthritis Rheum 2013; 65: 1-11.
DOI: https://doi.org/10.1002/art.37715
Pagnoux C, Seror R, Henegar C, Mahr A, Cohen P, Le Guern V, et al. Clinical features and outcomes in 348 patients with polyarteritis nodosa: a systematic retrospective study of patients diagnosed between 1963 and 2005 and entered into the French vasculitis study group database. Arthritis Rheum 2010; 62: 616-26.
DOI: https://doi.org/10.1002/art.27240
Lightfoot Jr RW, Michel BA, Bloch DA, Hunder GG, Zvaifler NJ, McShane DJ, et al. The American College of Rheumatology 1990 criteria for the classification of polyarteritis nodosa. Arthritis Rheum 1990; 33: 1088-93.
DOI: https://doi.org/10.1002/art.1780330805
Albi G, del Campo L, Tagarro D. Wünderlich's syndrome: causes, diagnosis and radiological management. Clin Radiol 2002; 57: 840-5.
DOI: https://doi.org/10.1053/crad.2002.0981
Katabathina VS, Katre R, Prasad SR, Surabhi VR, Shanbhogue AK, Sunnapwar A. Wunderlich syndrome: cross-sectional imaging review. J Comput Assist Tomogr 2011; 35: 425-33.
DOI: https://doi.org/10.1097/RCT.0b013e3182203c5e
Zhang JQ, Fielding JR, Zou KH. Etiology of spontaneous perirenal hemorrhage: a meta-analysis. J Urol 2002; 167: 1593-6.
DOI: https://doi.org/10.1016/S0022-5347(05)65160-9
Chen YC, Lin YC. Wunderlich syndrome. QJM 2012; 106: 187-8.
DOI: https://doi.org/10.1093/qjmed/hcr266
Bromfield B, Tellez R, Novelli P, Duarte-Rojo A. Hepatic artery pseudoaneurysms and hepatic ischaemic injury: a rare complication of polyarteritis nodosa. BMJ Case Rep 2022; 15: e251432.
DOI: https://doi.org/10.1136/bcr-2022-251432
Chung SA, Gorelik M, Langford CA, Maz M, Abril A, Guyatt G, et al. 2021 American College of Rheumatology/Vasculitis Foundation guideline for the management of polyarteritis nodosa. Arthritis Rheumatol 2021; 73: 1384-93.
DOI: https://doi.org/10.1002/art.41776
Gayraud M, Guillevin L, le Toumelin P, Cohen P, Lhote F, Casassus P, et al. Long-term followup of polyarteritis nodosa, microscopic polyangiitis, and Churg-Strauss syndrome: analysis of four prospective trials including 278 patients. Arthritis Rheum 2001; 44: 666-75.
DOI: https://doi.org/10.1002/1529-0131(200103)44:3<666::AID-ANR116>3.3.CO;2-1
How to Cite
Oliveira, D., Martins, A., Martins, F., Rato, M., Pinheiro, F., Fonseca, D., … Costa, L. (2024). Wunderlich syndrome as a rare complication of polyarteritis nodosa: a case report. Reumatismo, 76(1). https://doi.org/10.4081/reumatismo.2024.1669
Copyright (c) 2024 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
Similar Articles
- A. Bontadi, A. Ruffatti, S Giannini, E. Falcinelli, M. Tonello, A. Hoxha, P. Gresele, L. Punzi, In vitro effect of anti-β2 glycoprotein I antibodies on P-selectin expression, a marker of platelet activation , Reumatismo: Vol. 64 No. 1 (2012)
- A. Minelli, A. Vaona, Effectiveness of cognitive behavioral therapy in the treatment of fibromyalgia syndrome: a meta-analytic literature review , Reumatismo: Vol. 64 No. 3 (2012)
- S. Bello, A. Rinaldi, S. Trabucco, L. Serafino, C. Bonali, G. Lapadula, Erasmus syndrome in a marble worker , Reumatismo: Vol. 67 No. 3 (2015)
- M. E. Tezcan, Ş. Demir, M. Sargın, M. Aliustaoğlu, B. Göker, Sjögren’s syndrome and mean platelet volume , Reumatismo: Vol. 67 No. 1 (2015)
- E. Chessa, M. Piga, A. Floris, A. Mathieu, A. Cauli, Demyelinating syndrome in SLE: review of different disease subtypes and report of a case series , Reumatismo: Vol. 69 No. 4 (2017)
- M. Capraro, M. Dalla Valle, M. Podswiadek, P. De Sandre, E. Sgnaolin, R. Ferrari, The role of illness perception and emotions on quality of life in fibromyalgia compared with other chronic pain conditions , Reumatismo: Vol. 64 No. 3 (2012)
- I. Ben Ghorbel, N. Belfeki, M.H. Houman, Intracardiac thrombus in Behçet’s disease , Reumatismo: Vol. 68 No. 3 (2016)
- C. Giacomelli, R. Talarico, C. Baldini, L. Bazzichi, Pain in Sjögren’s syndrome , Reumatismo: Vol. 66 No. 1 (2014)
- S. Scriffignano, F.M. Perrotta, M. Ricci, B. Carabellese, E. Lubrano , Visceral muscle dysmotility syndrome in systemic lupus erythematosus: which is the role of 18 fluorodeoxyglucose-positron emission tomography-computed tomography? A clinical case and literature review , Reumatismo: Vol. 76 No. 4 (2024)
- V. Grosso, E. Boveri, L. Bogliolo, C. Montecucco, R. Caporali, Diffuse alveolar hemorrhage as a manifestation of Behçet disease , Reumatismo: Vol. 65 No. 3 (2013)
You may also start an advanced similarity search for this article.
