title: The significance of adrenal hemorrhage: undiagnosed Waterhouse-Friderichsen syndrome, a case series.
abstract: A retrospective series of five cases of nontraumatic gross adrenal hemorrhage were identified in 800 consecutive forensic autopsies. All patients were males, of different ethnicities and with ages ranging from 2 to 48 years. All patients had a clinical history and autopsy findings suggestive of sepsis. Pre- or postmortem microbiological cultures were variably positive for Pseudomonas aeruginosa, Streptococcus pneumoniae, Staphylococcus aureus, and methicillin-resistant Staphylococcus aureus. The fifth case was positive for yeast and a coagulase negative staphylococcus; contamination of this culture medium cannot be excluded. No cases had a culture positive for Neisseria meningitidis. We find that the reviewed patients with grossly or microscopically identifiable adrenal hemorrhage were otherwise healthy individuals who died suddenly as a consequence of bacterial infection. In each case, signs and symptoms compatible with premortem adrenal insufficiency were reported; in no instance was the adrenal hemorrhage clinically identified.
authors: Department of Pathology and Laboratory Medicine, Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29466, USA. Tormos@musc.edu
authors: Lee Marie
authors: LM
authors: Tormos
authors: Cynthia A
authors: CA
authors: Schandl
mesh_terms: D000307:Adrenal Gland Diseases / Q000382:microbiology*; D000311:Adrenal Glands / Q000473:pathology; D000328:Adult; D002675:Child, Preschool; D003951:Diagnostic Errors; D049429:Forensic Pathology; D006470:Hemorrhage / Q000382:microbiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011552:Pseudomonas Infections / Q000150:complications / Q000175:diagnosis; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D012189:Retrospective Studies; D018805:Sepsis / Q000382:microbiology; D013290:Streptococcal Infections / Q000150:complications / Q000175:diagnosis; D014884:Waterhouse-Friderichsen Syndrome / Q000175:diagnosis*
keywords: Waterhouse-Friderichsen; adrenal hemorrhage; adrenocortical insufficiency; autopsy; forensic pathology; forensic science; sepsis; sudden death