title: [Waterhouse-Friderichsen syndrome associated to a Morganella morganii and Enterococcus faecium peritonitis].
abstract: About fifty to sixty percent of patients with septic shock acquire acute adrenal insufficiency. This insufficiency is most often relative, but can sometimes be absolute. Bilateral adrenal haemorrhage is a rare aetiology of absolute acute adrenal insufficiency. It is classically described in patients with severe meningococcemia (purpura fulminans), who commonly present many of the risk factors associated with bilateral adrenal haemorrhage (shock, coagulation disorders, sepsis). We report a case of bilateral adrenal haemorrhage during a peritonitis complicated by a septic shock, with no coagulation disorder. This observation shows up that this bilateral adrenal haemorrhage can complicate severe sepsis of various origins, and not only severe meningococcemia. It can be suspected in face of a septic shock with an unfavourable evolution despite adequate treatment.
authors.affiliation: Département d'anesthésie-réanimation chirurgicale et Samu, CHU, 1, rue de Germont, 76031 Rouen cedex, France.
authors.forename: F
authors.initials: F
authors.lastname: Tourrel
authors.forename: P
authors.initials: P
authors.lastname: Gouin
authors.forename: B
authors.initials: B
authors.lastname: Dureuil
authors.forename: B
authors.initials: B
authors.lastname: Veber
mesh_terms: D000293:Adolescent; D000307:Adrenal Gland Diseases / Q000150:complications* / Q000382:microbiology; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004756:Enterobacteriaceae Infections / Q000150:complications*; D016984:Enterococcus faecium; D016908:Gram-Positive Bacterial Infections / Q000150:complications*; D006470:Hemorrhage / Q000150:complications* / Q000382:microbiology; D006801:Humans; D008297:Male; D020613:Morganella morganii; D012772:Shock, Septic / Q000503:physiopathology; D016896:Treatment Outcome; D014884:Waterhouse-Friderichsen Syndrome / Q000209:etiology* / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents