Parthasarathi A, Ahmad Amin M, Sharma R, et al. Waterhouse-Friderichsen syndrome. Reference article, Radiopaedia.org (Accessed on 25 Mar 2025) https://doi.org/10.53347/rID-12670
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 syndromeis due to septicemia and common infective agents include 5:
Neisseria meningitidis (meningococcus): classically-described cause
Haemophilus influenzae
Pseudomonas aeruginosa
Escherichia coli
Streptococcus pneumoniae
Radiographic features
Imaging features are often that of non-traumatic adrenal hemorrhage. The correct clinical context is vital in image interpretation.
History and etymology
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!
6. Saad AF, Ford KL, Deprisco G et-al. Adrenomegaly and septic adrenal hemorrhage (Waterhouse-Friderichsen syndrome) in the setting of congenital adrenal hyperplasia. Proc (Bayl Univ Med Cent). 2013;26 (3): 268-9. Free text at pubmed - Pubmed citation
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