Waterhouse-Friderichsen Syndrome Induced by Pneumococcemic Shock

Abstract

A 54-year-old woman with a brief febrile illness presented with shock and ecchymoses. Coagulation studies demonstrated thrombocytopenia, hypofibrinogenemia, prolonged thrombin and prothrombin times, and circulating fibrin split products. The autopsy disclosed a pneumococcal bacteremia (with early changes suggesting pneumonia), bilateral hemorrhagic necrosis of the adrenals (the Waterhouse-Friderichsen syndrome) and a small previously infarcted spleen. A review of six previous reports of the Waterhouse-Friderichsen syndrome complicating pneumococcal bacteremia revealed splenic abnormalities in four. Splenic pathology and shock are suggested as important concomittants of this very rare complication of pneumococcal infection.