Wunderlich syndrome in a COVID-19 patient with poor outcome

A 42-years-old female presented with loss of consciousness and gross hematuria. Physical and laboratory examination indicated hemorrhagic shock. CT-Scan showed massive retroperitoneal hemorrhage on left kidney. The patient needed selective arterial embolization, but the facility was not available for COVID-19 patients who require a negative-pressure room. The patient underwent renal exploratory laparotomy and right nephrectomy, but did not survive due to multiple organ dysfunction syndromes. Wunderlich syndrome is a severe hemorrhagic complication in COVID-19. The three symptoms are known as Lenk's triad which includes hypovolemic shock, acute flank pain, and flank mass.