Spontaneous Renal Artery Dissection with Bilateral Renal Infarction Successfully Treated with Rivaroxaban

Spontaneous renal artery dissection (SRAD) causing bilateral renal infarction is a rare condition. It may present with nonspecific symptoms, resulting in delayed diagnosis. We report a case of SRAD in an adult male who presented with flank pain and fever. The patient was initially worked up for possible pyelonephritis, which came back negative. Later, a diagnosis of SRAD with bilateral renal infarction was made on contrast-enhanced computed tomography (CT) abdomen followed by CT angiogram. The patient was treated with rivaroxaban and antihypertensive therapy. He was followed up for 12 months after the initial presentation and repeat imaging showed no new infarcts and a stable renal function.