Bilateral Spontaneous Renal Hematoma or Wünderlich Syndrome: A Rare and Life-Threatening Clinical Entity

Wünderlich syndrome (WS) is an unusual clinical condition defined by spontaneous perirenal space hemorrhage or subcapsular renal hemorrhage without antecedent of traumatic history, often triggered by various factors. It manifests mainly as abdominal pain and fever. As the signs and symptoms are nonspecific, imaging studies are essential for diagnosing and ruling out differential diagnoses. We present a case of a 42-year-old female with no previous pathological or traumatic history, who was admitted with abdominal pain and episodes of fever, attributed to bilateral spontaneous renal hematomas. We conducted a comprehensive clinical history to rule out metabolic, autoimmune, infectious, traumatic, or congenital factors. Laboratory tests for autoimmune, infectious, coagulation, and metabolic causes were all negative. An abdominal contrast-enhanced computed tomography revealed a bilateral renal hemorrhage, ruling out other abdominal causes of pain and confirming a bilateral WS. The patient underwent fluoroscopy-guided drainage and biopsy because we did not have an accurate diagnosis based on the imaging reports, which indicated either pure hematomas or renal abscesses. We ruled out any tumoral or infectious process with the drainage samples. After a thorough consideration and elimination of all possible causes, we arrived at the diagnosis of an idiopathic bilateral WS, an infrequent medical occurrence.