{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T08:11:15Z","timestamp":1779351075471,"version":"3.51.4"},"reference-count":12,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T00:00:00Z","timestamp":1779321600000},"content-version":"vor","delay-in-days":140,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Case Reports in Hematology"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Wunderlich syndrome (WS) is a spontaneous, nontraumatic intrarenal or perirenal hemorrhage most commonly related to renal neoplasms, vascular disorders, infection, cyst rupture, or anticoagulation. Clinical severity ranges from self\u2010limited bleeding to hemorrhagic shock.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case<\/jats:title>\n                    <jats:p>We report a 58\u2010year\u2010old woman with triple\u2010negative myelofibrosis (MF) who was started on hydroxyurea (HU) 500\u2009mg\/day and low\u2010dose acetylsalicylic acid (ASA). On Day 60, she presented with bilateral perirenal and intrarenal hemorrhage confirmed by contrast\u2010enhanced abdominal computed tomography. ASA was discontinued and bleeding ceased spontaneously. One month later, she represented with recurrent bilateral hemorrhage without ASA exposure and marked neutrophilic leukocytosis. Concomitant purpuric skin lesions, positive antinuclear antibodies (ANA, 1:160), and low C3 levels raised suspicion for a HU\u2010associated vasculitic process; HU was discontinued. Coagulation parameters at the time of bleeding (INR: 1.2, aPTT: 26.4\u2009s, fibrinogen: 348\u2009mg\/dL, and D\u2010dimer: 0.6\u2009\u03bcg\/mL) were not consistent with disseminated intravascular coagulation. Despite supportive management, the patient\u2019s condition deteriorated and she died shortly thereafter. The exact cause of death could not be definitively determined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>To our knowledge, this is the first reported case of WS in a patient with MF receiving HU therapy. Clinicians should consider WS in HU\u2010treated patients presenting with acute flank pain or hematuria and evaluate for potential vasculitic features.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1155\/crh\/5518867","type":"journal-article","created":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T08:03:03Z","timestamp":1779350583000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Hydroxyurea\u2010Associated Wunderlich Syndrome in Triple\u2010Negative Myelofibrosis: A Case Report and Literature Review"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5244-3733","authenticated-orcid":false,"given":"Veysel","family":"Erol","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4705-5810","authenticated-orcid":false,"given":"Zeki","family":"G\u00fczel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-5551-8048","authenticated-orcid":false,"given":"\u0130brahim Ethem","family":"Akg\u00fcn","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2805-8664","authenticated-orcid":false,"given":"G\u00f6khan","family":"Ecer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,5,21]]},"reference":[{"key":"e_1_2_10_1_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2008-07-170449"},{"key":"e_1_2_10_2_2","doi-asserted-by":"publisher","DOI":"10.4103\/0974-2700.55346"},{"key":"e_1_2_10_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF02799543"},{"key":"e_1_2_10_4_2","doi-asserted-by":"publisher","DOI":"10.21276\/ijcmsr.2019.4.1.22"},{"key":"e_1_2_10_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005392-200204000-00006"},{"key":"e_1_2_10_6_2","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.30386"},{"key":"e_1_2_10_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2018.04.045"},{"key":"e_1_2_10_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.toxicon.2022.06.004"},{"key":"e_1_2_10_9_2","doi-asserted-by":"publisher","DOI":"10.2169\/internalmedicine.52.0242"},{"key":"e_1_2_10_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5347(17)40097-8"},{"key":"e_1_2_10_11_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2230.2001.00913.x"},{"key":"e_1_2_10_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.urology.2008.11.062"}],"container-title":["Case Reports in Hematology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/crh\/5518867","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1155\/crh\/5518867","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/crh\/5518867","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T08:03:04Z","timestamp":1779350584000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1155\/crh\/5518867"}},"subtitle":[],"editor":[{"given":"Rounak","family":"Dubey","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":12,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1155\/crh\/5518867"],"URL":"https:\/\/doi.org\/10.1155\/crh\/5518867","archive":["Portico"],"relation":{},"ISSN":["2090-6560","2090-6579"],"issn-type":[{"value":"2090-6560","type":"print"},{"value":"2090-6579","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"2025-11-04","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-02","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-21","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"5518867"}}