Waterhouse-Friderichsen syndrome (WFS) is a collection of symptoms resulting from the failure of the adrenal glands to function normally as a result of bleeding into the gland.
Fulminant meningococcemia - Waterhouse-Friderichsen syndrome; Fulminant meningococcal sepsis - Waterhouse-Friderichsen syndrome; Hemorrhagic adrenalitis
The adrenal glands are two triangle-shaped glands. One gland is located on top of each kidney. The adrenal glands produce and release different hormones that the body needs to function normally. The adrenal glands can be affected by many diseases, such as infections like WFS.
WFS is caused by severe infection with meningococcus bacteria or other severe infection from bacteria, such as:
- Group B streptococcus
- Pseudomonas aeruginosa
- Streptococcus pneumoniae
- Staphylococcus aureus
Symptoms and signs usually come on very suddenly. They are due to the bacteria growing (multiplying) inside the body. Symptoms include:
- Fever and chills
- Joint and muscle pain
Infection with bacteria causes bleeding throughout the body, which causes:
- Bodywide rash
- Disseminated intravascular coagulation in which small blood clots cut off blood supply to the organs
- Septic shock
Bleeding into the adrenal glands causes adrenal crisis, in which not enough adrenal hormones are produced. This leads to symptoms such as:
- Dizziness, weakness
- Very low blood pressure
- Very fast heart rate
- Confusion or coma
Exams and Tests
The health care provider will perform a physical examination and ask about the person's symptoms.
Blood tests will be done to help confirm if the infection is caused by bacteria. Tests may include:
If the provider suspects the infection is caused by meningococcus bacteria, other tests that may be done include:
- Lumbar puncture to get a sample of spinal fluid for culture
- Skin biopsy and Gram stain
- Urine analysis
Tests that may be ordered to help diagnose acute adrenal crisis include:
- ACTH (cosyntropin) stimulation test
- Cortisol blood test
- Blood sugar
- Potassium blood test
- Sodium blood test
- Blood pH test
Treatment involves giving antibiotics as soon as possible to treat the bacterial infection. Glucocorticoid medicines will also be given to treat adrenal gland problem. Supportive treatments will be needed for other symptoms.
WFS is fatal unless treatment for the bacterial infection is started right away and glucocorticoid drugs are given.
To prevent WFS caused by meningococcal bacteria, a vaccine is available.
Stephens DS, Apicella MA. Neisseri meningitides. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, Updated Edition. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 213.
Stewart PM, Newell-Price JDC. The adrenal cortex. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology. 13th ed. Philadelphia, PA: Elsevier; 2016:chap 15.
Reviewed By: Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.