{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:02:31Z","timestamp":1756339351518,"version":"3.44.0"},"reference-count":24,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2024,2,20]]},"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:p>An elderly female patient with left pyelonephritis developed worsening left flank pain, hypotension and a drop in haemoglobin (Hb) from 97 g\/L to 67g\/L on the third day of her admission. There was no recent trauma, history of coagulopathy or risk factors for renal malignancy or vascular disease.<\/jats:p>\n               <jats:p>A contrasted CT scan of the kidneys revealed a 3.8\u2009cm left renal subcapsular haematoma with no active contrast extravasation. Her atraumatic subcapsular haematoma fulfils two out of three clinical features of Lenk\u2019s triad (acute flank pain, hypovolaemic shock), suggestive of Wunderlich syndrome. Urine and blood cultures grew <jats:italic>Klebsiella pneumoniae<\/jats:italic> and she was managed conservatively with culture-directed antibiotics, fluids and blood products.<\/jats:p>\n               <jats:p>Wunderlich syndrome is a rare complication of pyelonephritis and should be considered in patients with pyelonephritis who develop acute severe flank pain, Hb drop and haemodynamic instability. Appropriate medical and surgical therapies need to be instituted early to ensure good outcomes.<\/jats:p>","DOI":"10.1136\/bcr-2023-257325","type":"journal-article","created":{"date-parts":[[2024,3,5]],"date-time":"2024-03-05T12:05:12Z","timestamp":1709640312000},"page":"e257325","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Wunderlich syndrome in a patient with pyelonephritis"],"prefix":"10.1136","volume":"17","author":[{"given":"Joshua Chin Howe","family":"Chia","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Singapore General Hospital, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chiara Jiamin","family":"Chong","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Singapore General Hospital, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yan Rong","family":"Yong","sequence":"additional","affiliation":[{"name":"Department of Radiology, Changi General Hospital, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Poh Yong","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Singapore General Hospital, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,3,5]]},"reference":[{"key":"2025082700191716000_17.3.e257325.1","doi-asserted-by":"crossref","unstructured":"Ahmad M , Arora M , Reddu R , et al . 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