Waterhouse-Friderichsen syndrome

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. 

Pathology

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

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.