Waterhouse-Friderichsen syndrome

Last revised by Dr Daniel J Bell on 01 Feb 2020

Waterhouse-Friderichsen syndrome (also known as purpura fulminans 9 or hemorrhagic adrenalitis 10) is characterized by adrenal insufficiency that results from atraumatic adrenal hemorrhage in consequence of septicemia. 

Waterhouse-Friderichsen syndrome is due to septicemia and common infective agents include 5:

  • Neisseria meningitidis (meningococcus): classically-described cause
  • Haemophilus influenzae
  • Pseudomonas aeruginosa
  • Escherichia coli
  • Streptococcus pneumoniae

Imaging features are often that of non-traumatic adrenal hemorrhage. The correct clinical context is vital in image interpretation.

It is named after Rupert Waterhouse, English physician (1873-1958) 8, and Carl Friderichsen, Danish pediatrician (20th century) 2. The latter reported his first 30 cases in 1918 10, writing a follow-up article in 1955 detailing another 250 cases! 11.

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