title: Fatal Waterhouse-Friderichsen syndrome due to Ewingella americana infection.
abstract: A fatal case of Waterhouse-Friderichsen syndrome resulting from infection in a previously healthy 74-year-old woman is reported. The patient died suddenly within 14 hours after presentation. The diagnosis of Waterhouse-Friderichsen syndrome as the cause of death was established post mortem based on autopsy findings, microscopic examination, measurement of serum procalcitonin concentration (113 ng/ml), and outcome of postmortem bacteriologic cultures that grew in heart and spleen blood samples. Since the introduction of as a new group in the family in 1983, more recent case studies have established its clinical significance and pathogenic potential to cause severe, life-threatening bacteremia and sepsis. is a rare pathogen that should be added to the list of unusual bacteria causing Waterhouse-Friderichsen syndrome.
authors.affiliation: Institute of Legal Medicine, Department of Forensic Pathology, Hamburg, Germany. mtsokos@web.de
authors.forename: Michael
authors.initials: M
authors.lastname: Tsokos
mesh_terms: D000368:Aged; D002116:Calcitonin / Q000097:blood; D015740:Calcitonin Gene-Related Peptide; D004755:Enterobacteriaceae / Q000302:isolation & purification*; D004756:Enterobacteriaceae Infections / Q000175:diagnosis* / Q000382:microbiology*; D017809:Fatal Outcome; D005260:Female; D006321:Heart / Q000382:microbiology; D006801:Humans; D011498:Protein Precursors / Q000097:blood; D013154:Spleen / Q000382:microbiology; D014884:Waterhouse-Friderichsen Syndrome / Q000175:diagnosis* / Q000382:microbiology*
chemical_list: C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide