Wunderlich syndrome (WS) is a rare but life-threatening condition characterised by spontaneous, non-traumatic renal haemorrhage confined to the perirenal and subcapsular space. It is typically accompanied by acute flank pain, a flank mass, and hypovolemic shock, known as Lenk's triad. WS can be classified into neoplastic and non-neoplastic origins, with up to 60% of cases caused by benign neoplasms such as angiomyolipoma and malignancies such as renal cell carcinoma. Non-neoplastic causes include vasculitis, renal artery aneurysm, arteriovenous malformation, nephritis, coagulopathy, and infectious processes.

Patient’s data was collected through the analysis of official records, including renal functional evaluations, ultrasound, and CT imaging.

In this report, we present the case of a previously healthy 56-year-old man who developed fever, left flank pain, and hematuria of 2-week duration during a pilgrimage in the Middle East. A vague left flank mass with tenderness was found upon abdominal examination. Contrast-enhanced CT revealed bilateral perinephric haemorrhage; left more than right, without evidence of abnormal vascularity or renal mass, leading to a diagnosis of WS likely caused by an infection from recent travel. A repeated CT scan showed no significant changes, and the patient remained hemodynamically stable, leading to conservative treatment. Percutaneous drainage of the collection was planned for the patient.

In conclusion, it is crucial to recognise perinephric haemorrhage, which can resemble WS, and CECT should be the standard imaging modality for diagnosis.