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: 438
PDF: 293
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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
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