# A Rare Case of Apixaban-Related Spontaneous Perinephric Hematoma Complicated by Multiorgan Dysfunction

## TL;DR

A 63-year-old man on apixaban developed a life-threatening kidney hematoma and multiorgan failure, highlighting risks of anticoagulant use.

## Contribution

Presents a rare clinical case linking apixaban use to severe complications from spontaneous perinephric hematoma.

## Key findings

- Apixaban use was associated with a large perinephric hematoma in a patient with atrial fibrillation.
- The patient's condition worsened with acute kidney injury, ileus, and respiratory failure.
- The case resulted in death due to hypoxic respiratory failure and cardiac arrest.

## Abstract

Spontaneous perinephric hematomas are rare but potentially life-threatening events, often associated with anticoagulation therapy. We report a case of a 63-year-old male patient on apixaban for paroxysmal atrial fibrillation who presented with acute abdominal and flank pain and was found to have a large left-sided perinephric hematoma. His clinical course was complicated by acute kidney injury, ileus, respiratory failure requiring mechanical ventilation, and eventual death from hypoxic respiratory failure and cardiac arrest. This case underscores the diagnostic and therapeutic challenges in managing spontaneous retroperitoneal hemorrhage, especially in the setting of anticoagulation, and highlights the importance of early recognition and multidisciplinary management.