Exploring the Relationship Between Disseminated Intravascular Coagulation and Waterhouse–Friderichsen Syndrome

Year : 2026 | Volume : 16 | Issue : 02 | Page : 45 49
    By

    Deepa Narayan Naik,

  • Juliet Dsouza,

  1. Assistant Lecturer, Department of Nursing, R.N.S College of Nursing, Mavalli, Karnataka, India
  2. Assistant Lecturer, Department of Nursing, R.N.S College of Nursing, Mavalli, Karnataka, India

Abstract

Waterhouse–Friderichsen syndrome was first identified as a distinct clinical entity by Little in 1901. He described four cases from his own observations and, after examining existing literature, identified eight additional cases that he considered previously unclassified. One case in his report may have involved purpura resulting from a different cause. The knowledge of this unusual disorder developed slowly from several significant clinical observations and case reports during the first two decades of the 20th century. In 1911, William Waterhouse published a report detailing an additional case in England, as well as a review of 15 cases that had been previously published. Waterhouse’s review is regarded as one of the first comprehensive descriptions of the clinical features, pathological changes, and progression of this syndrome, contributing to the recognition of it as a separate medical condition. Then in 1918, Dr. M. Friderichsen published another two cases from Germany and provided an extensive analysis of the cases previously published by Dr. E. Little, in addition to sixteen other cases found in the medical literature. Dr. Friderichsen’s research contributed to a greater understanding at that time of the clinical features and pathological basis of this syndrome. In 1934, Dr. V. Bamatter published a detailed review of 38 cases, including two cases that he had seen in his own practice. This comprehensive review of the literature provided additional information on the syndrome and provided a more solid foundation for its diagnosis and clinical recognition.

Keywords: Waterhouse–Friderichsen syndrome, bilateral adrenal haemorrhage, meningococcal infection, medical malpractice, Clinical features

[This article belongs to Research and Reviews: A Journal of Medicine ]

How to cite this article:
Deepa Narayan Naik, Juliet Dsouza. Exploring the Relationship Between Disseminated Intravascular Coagulation and Waterhouse–Friderichsen Syndrome. Research and Reviews: A Journal of Medicine. 2026; 16(02):45-49.
How to cite this URL:
Deepa Narayan Naik, Juliet Dsouza. Exploring the Relationship Between Disseminated Intravascular Coagulation and Waterhouse–Friderichsen Syndrome. Research and Reviews: A Journal of Medicine. 2026; 16(02):45-49. Available from: https://journals.stmjournals.com/rrjom/article=2026/view=249781


References

  1. Aegerter EE. The Waterhouse-Friderichsen syndrome: Review of the literature and a report of two cases. JAMA. 1936;106(20):1715–1719.
  2. Tsokos M. Postmortem measurement of serum procalcitonin concentration in Waterhouse-Friderichsen syndrome. Virchows Arch. 2002;441(6):629–631. doi: 1007/s00428-002-0710-5.
  3. Böhm N. Adrenal, cutaneous and myocardial lesions in fulminating endotoxinemia (Waterhouse-Friderichsen syndrome). Pathol Res Pract. 1982;174(1–2):92–105. doi: 1016/S0344-0338(82)80063-3.
  4. Garland J, Tse R, Cala AD. Neisseria meningitidis isolated in postmortem vitreous humor in a death due to meningococcal sepsis. Am J Forensic Med Pathol. 2016;37(4):233–235. doi: 1097/PAF.
    0000000000000263.
  5. Varon J, Chen K, Sternbach GL. Rupert Waterhouse and Carl Friderichsen: Adrenal apoplexy. J Emerg Med. 1998;16(4):643–647. doi: 1016/S0736-4679(98)00059-3.
  6. Ryan CA, Wenman W, Henningsen C, Tse S. Fatal childhood pneumococcal Waterhouse-Friderichsen syndrome. Pediatr Infect Dis J. 1993;12(3):250–251.
  7. Harris P, Bennett A. Waterhouse-Friderichsen syndrome. N Engl J Med. 2001;345(11):841. doi: 1056/NEJM200109133451116.
  8. Mühlig K, Theile J, Dalitz E. Einseitige Nebennierenblutung – ein Waterhouse-Friderichsen-Syndrom? Ultraschall Med. 1995;16(6):293–296.
  9. Tormos LM, Schandl CA. The significance of adrenal hemorrhage: Undiagnosed Waterhouse-Friderichsen syndrome, a case series. J Forensic Sci. 2013;58(4):1071–1074. doi: 1111/1556-4029.12149.
  10. Gentile G, Amadasi A, Bailo P, Boracchi M, Maciocco F, Marchesi M, et al. The importance of the postmortem interval for the diagnosis of Waterhouse-Friderichsen syndrome by Neisseria meningitidis in a series of forensic cases. Autops Case Rep. 2019;9(3):e2019103. doi: 4322/
    acr.2019.103.
  11. Mok Q, Butt W. The outcome of children admitted to intensive care with meningococcal septicaemia. Intensive Care Med. 1996;22(3):259–263. doi: 1007/BF01712249.
  12. Ventura F, Bonsignore A, Portunato F, Orcioni GF, Varnier OE, De Stefano F. A fatal case of streptococcal and meningococcal meningitis in a 2-year-old child occurring as Waterhouse-Friderichsen syndrome. J Forensic Leg Med. 2013;20(6):678–682. doi: 1016/j.jflm.2013.03.020.
  13. Rijal R, Kandel K, Aryal BB, Asija A, Shrestha DB, Sedhai YR. Waterhouse-Friderichsen syndrome, septic adrenal apoplexy. In: Litwack G, editor. Vitamins and Hormones. Vol. 124. Cambridge (MA): Academic Press; 2024. p. 449–461. doi: 1016/bs.vh.2023.10.013.
  14. Karki BR, Sedhai YR, Syed. Waterhouse-Friderichsen Syndrome. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551510/
  15. Rao RH, Vagnucci AH, Amico JA. Bilateral massive adrenal hemorrhage: Early recognition and treatment. Ann Intern Med. 1989;110(3):227–235. doi: 7326/0003-4819-110-3-227.
  16. Sonavane A, Baradkar V, Salunkhe P, Kumar S. Waterhouse-Friderichsen syndrome in an adult patient with meningococcal meningitis. Indian J Dermatol. 2011;56(3):326–328. doi: 4103/0019-5154.82496.
  17. Udobi KF, Childs EW. Adrenal crisis after traumatic bilateral adrenal hemorrhage. J Trauma. 2001;51(3):597–600. doi: 1097/00005373-200109000-00030.
  18. Ikeda O, Urata J, Araki Y, Kume S, Torigoe Y, et al. Acute adrenal hemorrhage after blunt trauma. Abdom Imaging. 2007;32(2):248–252. doi: 1007/s00261-006-9017-3.
Regular Issue Subscription Review Article
Volume 16
Issue 02
Received 25/05/2026
Accepted 08/06/2026
Published 16/07/2026
Publication Time 52 Days
16

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