Anticoagulation induced Wunderlich Syndrome causing page kidney in a young patient with Systemic Lupus Erythematosus: a case report and review of literature

Abstract Background Spontaneous renal hemorrhage (SRH), also known as Wunderlich syndrome, is a rare but potentially fatal emergency classically presenting with Lenk’s triad of flank pain, palpable mass, and hypovolemia. When associated with Page kidney—a cause of secondary hypertension due to external renal compression—the diagnostic challenge increases. Although SRH is most commonly linked to renal neoplasms and vascular abnormalities, its occurrence as an iatrogenic complication of anticoagulation is uncommon and has been rarely reported in systemic lupus erythematosus (SLE). Case presentation We report a young woman with active SLE and peripheral vasculitis who developed massive SRH two days after initiation of therapeutic anticoagulation. Imaging demonstrated a large right subcapsular hematoma causing Page kidney. Immediate cessation of anticoagulation, hemodynamic resuscitation, and timely surgical evacuation resulted in renal salvage and clinical recovery. Conclusions This case highlights a unique and previously unreported association of anticoagulation-induced SRH with Page kidney in a patient with SLE. It underscores the importance of early imaging, multidisciplinary management, and careful risk–benefit assessment when initiating anticoagulation in high-risk patients.