Search

A 26-year-old woman presented to a local community hospital with fever and abdominal pain. Clinical examination showed mild abdominal and bilateral lumbar tenderness. Blood analysis showed C-reactive protein of 401 mg/l, leukocyte count of 15,340/mm3, and serum creatinine of 71 μmol/l. Chest radiograph and abdominal ultrasound were normal. She was diagnosed with pyelonephritis despite negative urinalysis and was discharged. Soon after, her condition worsened with 5 kg weight loss, myalgia, and arthralgia. Two months later, she was readmitted with severe left flank pain. Contrast-enhanced abdominal computed tomography (CT) showed a large subcapsular hematoma surrounding the left kidney (Figure 1). Multiple bilateral intrarenal aneurysms of variable diameter (1–14 mm) were detected during the arterial phase (Figure 1) with the appearance of bunch of grapes. Multiple bilateral wedge-shaped low-attenuation involving cortex and medulla suggesting kidney infarcts were also detected (Supplementary Figure 1 online). Urinalyses showed microscopic hematuria and proteinuria of 0.9 g/24 h. Comprehensive autoimmune including Anti-neutrophil cytoplasmic antibodies (ANCA) research and viral screenings were negatives.