Life-Threatening Wunderlich Syndrome Associated with Apixaban and the Complexity of Anticoagulation Management in Bleeding Patients: A Case Report.

Wunderlich syndrome is a rare and possibly life-threatening haemorrhagic syndrome presenting as spontaneous nontraumatic renal rupture with subcapsular and perinephric haemorrhage. Apixaban, a direct oral anticoagulant recommended in patients with atrial fibrillation, has previously been associated with atraumatic solid organ rupture but, to date, no case of apixaban-related Wunderlich syndrome has been reported. We report a rare case of Wunderlich syndrome associated with apixaban while addressing the difficulties face by clinicians when managing anticoagulation in bleeding patients.

A síndrome de Wunderlich é uma síndrome hemorrágica rara caracterizada por rutura renal espontânea, não-traumática, com hemorragia subcapsular e peri-renal. O apixabano, um anticoagulante oral direto recomendado em doentes com fibrilação auricular, foi associado no passado a rutura atraumática de órgãos sólidos mas, à data, nenhum caso de síndrome de Wunderlich associada ao apixabano foi reportado. Reportamos um caso raro de síndrome de Wunderlich associada ao apixabano abordando concomitantemente as dificuldades na gestão da anticoagulação em doentes com hemorragia.

Mitral Valve Infective Endocarditis Complicated With Coronary Artery Embolization.

Infective endocarditis is a multisystem and potentially fatal disease. Systemic embolization is a relatively common complication, the spleen and central nervous system being the most frequent sites for septic emboli formation. Coronary artery septic embolization is extremely uncommon and its management remains controversial. We present the case of a 50-year-old male diagnosed with mitral valve infective endocarditis complicated with spleen and central nervous system embolization, who developed acute myocardial infarction two weeks after disease onset. The patient was successfully treated with combined mitral valve replacement and coronary artery bypass grafting.

An Unusual Cause of Knee Mass: Osseous Hydatidosis.

Hydatid disease (hydatidosis) is a zoonotic infection caused by the larval stage of the parasitic tapeworm Echinococcus granulosus endemic in some sheep-raising areas. The liver and lungs are most commonly affected. Bone involvement (osseous hydatidosis) is distinctly uncommon, and its diagnosis and treatment can be challenging. We report a case of a 54-year-old male with right knee pain and edema and an extensive lesion on the femur; he was diagnosed with knee hydatidosis and was successfully treated with surgery and albendazole. This case reinforces the importance of the rare osseous hydatidosis as part of the differential diagnosis of bone lesions.