PAGE KIDNEY IN WUNDERLICH SYNDROME AFTER DUAL ANTIPLATELET THERAPY

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: We present a rare case of perinephric hemorrhage causing hypertension & clinically significant bleeding after initiation antiplatelet therapy. CASE PRESENTATION: A 44-year-old male with history medulloblastoma, status post resection irradiation, presented slurred speech ataxia. Cerebral angiogram showed bilateral vertebral artery proximal basilar occlusion, for which he underwent emergent thrombectomy stenting. He was then started on aspirin clopidogrel. day after, complained new-onset severe left flank pain fever, tachycardia, hypertension. Nicardipine drip given to control his blood pressure. Hemoglobin dropped from 15.7 11.4 g/dL. Serum creatinine increased 1.7 baseline 1.2 mg/dL. Urinalysis RBC 10-20/high-power field. Computed tomography (CT) the abdomen large renal subcapsular hematoma measuring 3.0 x 5.7 6.3 cm in size, delayed nephrograms recent endovascular stent placement, indicative function, but no evidence contrast extravasation or rupture. Given patient's stenting, therapy continued. Urology interventional radiology were consulted. The managed conservatively serial hemoglobin checks. Interval CT stable hematoma. Patient later had resolution acute kidney injury, discharged home close follow-up. DISCUSSION: Wunderlich syndrome is phenomenon characterized by sudden onset spontaneous hemorrhage. Due extrinsic compression parenchyma, renin-angiotensin-aldosterone system activated can result systemic known as Page kidney. Up 60% cases are caused neoplasm, smaller portion attributed vasculitis, aneurysm, arteriovenous malformation, vein thrombosis, nephritis, cystic disease, coagulopathy. In our case, there appreciable mass CT. It thought be secondary antiplatelets. Contrast-enhanced has 100% sensitivity gold-standard identifying aid embolization treatment. Management includes selective arterial surgery. Embolization minimally invasive; however, surgical intervention used when tumor needed prevent recurrent bleeding. CONCLUSIONS: life-threatening emergency. high index suspicion warranted patient who pain, hypertension, especially agents. REFERENCE #1: Dopson SJ, et al. cause hypertension: report review literature. Am J Kidney Dis. 2009 Aug;54(2):334-9. doi: 10.1053/j.ajkd.2008.11.014. Epub Jan 23. PMID: 19167799 #2: Lin YY, Diagnosis pain. Hong Kong Med J. 2019 Oct;25(5):406.e1-2. 10.12809/hkmj187718. 31761752 #3: Grassia M, Romano A, Esposito G, five days hemicolectomy colorectal cancer. Int Surg Rep. 2015;16:33-36. doi:10.1016/j.ijscr.2015.09.007 DISCLOSURES: No relevant relationships Luqman Baloch, source=Web Response Janine Beatrice Borja, Shadi Obeidat, Lintu Ramachandran,