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Case Reports
. 2018 May 25:162:D2344.

[The Waterhouse-Friderichsen syndrome]

[Article in Dutch]
Marc J G Zeldenrust  1   2 , Robert Jan van Suylen  3 , Bart P C Ramakers  1
Affiliations
  • PMID: 30040272
Case Reports

[The Waterhouse-Friderichsen syndrome]

[Article in Dutch]
Marc J G Zeldenrust et al. Ned Tijdschr Geneeskd. .

Abstract

Background: The Waterhouse-Friderichsen syndrome (WFS) is a serious illness associated with a high mortality rate and characterized by septic shock and signs of adrenocortical insufficiency.

Case description: A 33-year-old male was seen in the emergency department with severe abdominal and back pain with diffuse mottled skin and rapidly progressive petechiae all over his body. Laboratory results showed severe lactate acidosis with renal dysfunction and indications of diffuse intravascular coagulation. Because he had signs of progressive septic shock, the patient was admitted to the ICU. There he subsequently developed hypoglycaemia (glucose < 0.1 mmol/l) and CPR had to be performed twice - the patient died shortly afterwards. Autopsy showed bilateral necrosis and haemorrhage of the adrenal glands, indicative of the diagnosis of WFS. Streptococcus pneumoniae was identified.

Conclusion: In case of sepsis, with fever, rapidly expanding petechiae and purpura the Waterhouse-Friderichsen syndrome should be considered. Intensive therapy with antibiotics, fluids, vasopressors, and corticosteroids should be initiated immediately.

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