Waterhouse-Friderichsen syndrome

Waterhouse-Friderichsen syndrome (also known as purpura fulminans  or hemorrhagic adrenalitis ) 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 :

  • 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) , and Carl Friderichsen, Danish pediatrician (20th century) . The latter reported his first 30 cases in 1918 , writing a follow-up article in 1955 detailing another 250 cases! .

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