(876) Wunderlich Syndrome in Adolescence: A Case Report

Introduction: Wunderlich syndrome is characterized by the acute onset of spontaneous renal hemorrhage into the subcapsular, perirenal, and/or pararenal spaces, without preceding trauma. Patients can present with a wide range of symptoms, from nonspecific flank pain to severe manifestations such as hypovolemic shock. The classic symptom complex includes flank pain, a flank mass, and hypovolemic shock, known as Lenk's triad, but this is seen in only a small subset of patients. Epidemiologically, this condition is more prevalent in adults, with an average age of 46.8 years, and most cases occurring between 30 and 60 years.

Description: We report the case of a 17-year-old female patient, previously healthy, without reported comorbidities, who sought medical care due to right iliac fossa abdominal pain radiating to the back, associated with nausea and vomiting. Initially, the diagnostic hypothesis was pyelonephritis. Laboratory tests showed Hb 11.2; Ht 32.3; Platelets 261,000; Total leukocytes 19,700; CRP 0.1, associated with urinalysis revealing massive hematuria and absence of fever. Following the initiation of antibiotic therapy with ceftriaxone and subsequent laboratory and imaging evaluations, suspicion of Wunderlich syndrome was raised due to a grade V renal laceration with perirenal hemorrhage, without a history of trauma. Consequently, a nephrectomy was performed. The patient remained hospitalized for 13 days and was discharged in good clinical and hemodynamic condition.

Discussion: We report a rare case most prevalent in adult pacients. This case report aims to alert pediatricians and clinicians to the possibility of this syndrome occurring in adolescents.