Case Report: Retroperitoneal Urinoma and Pemphigus Vulgaris Complicated by Sepsis

Urinoma is an uncommon complication of urinary tract disruption. We present a unique case of a 70-year-old female with a complex medical history, including Pemphigus Vulgaris on chronic steroid therapy and deep vein thrombosis on anticoagulation, who developed a retroperitoneal urinoma and subsequent sepsis. The patient presented with hypotension, tachycardia, and somnolence. Imaging revealed an enlarging retroperitoneal hematoma. A sepsis workup was initiated, and a new left-sided hydronephrosis raised suspicion for urinary tract involvement. Interventional radiology-guided drainage confirmed a urinoma with heavy Proteus mirabilis growth. Her hospital course was complicated by the need to balance anticoagulation therapy for thrombosis with ongoing hemorrhagic risk due to chronic steroid use. Multidisciplinary management was essential in navigating diagnostic and therapeutic challenges, highlighting the importance of coordinated care in high-risk, medically complex patients.