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Waterhouse–Friderichsen syndrome as a result of non-meningococcal infection

¹ Department of Microbiology, Hairmyres Hospital, Glasgow G75 8RG, UK
² Department of Cellular Pathology, Peterborough District Hospital, Thorpe Road, Peterborough PE3 6DA, UK
³ Department of Microbiology, Papworth Hospital, Cambridgeshire CB3 8RE, UK
⁴ Department of Morbid Anatomy and Histopathology, Addenbrooke’s Hospital, Cambridge CB2 2QQ, UK

Correspondence to:
M D Harris
Department of Histopathology, Peterborough District Hospital, Thorpe Road, Peterborough PE3 6DA, UK; mike.harris{at}pbh-tr.nhs.uk
ABSTRACT
Waterhouse–Friderichsen syndrome—massive adrenal haemorrhage in the setting of overwhelming clinical sepsis—is usually taken at necropsy to indicate meningococcal infection, and may be the only evidence of this pathogen. This report describes three fatal cases of the syndrome in which the causative organism proved to be a streptococcus. The organisms were detected during routine coroners’ autopsies with histology and microbiological investigations. In two cases, the syndrome followed Streptococcus pneumoniae infection and in a third ß haemolytic streptococcus group A. Thus, adrenal haemorrhage alone cannot be taken to indicate meningococcal disease and other pathogens, particularly streptococcus, must be considered.

Keywords: Waterhouse-Friderichsen syndrome; adrenal haemorrhage; streptococcus; septicaemia; necropsy

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