Wunderlich Syndrome: Early Misdiagnosis with Acute Renal Colic During COVID-19 Pandemic

Wunderlich syndrome, also known as the spontaneous non-traumatic retroperitoneal hemorrhage, is an uncommon condition characterized by acute, spontaneous, non-traumatic renal hemorrhage into the subcapsular or perirenal spaces. The majority of the cases are caused by renal cell carcinoma or renal angiomyolipoma. Other causes are arteriovenous malformation, cystic renal disease, and anticoagulation medications. The classic presentation is “Lenk’s triad” of acute flank pain, palpable flank mass, and hypovolemia. The diagnosis is based on clinical suspicion and confirmed by a CT scan, which is the preferred imaging modality. Due to the rarity of these cases and the wide range of clinical manifestations, the treatment is divergent ranging from conservative management to nephrectomy. Herein, we present a case of massive right renal hemorrhage caused by warfarin toxicity that was initially misdiagnosed as acute renal colic due to the patient’s refusal to refer to the clinic during Corona Virus Disease- 19 era and was later managed with a right nephrectomy.