Waterhouse-Friderichsen syndrome is a catastrophic complication primarily associated with which organism, and what is the underlying pathological process in the adrenal glands?

• A Streptococcus pneumoniae; adrenal cortical atrophy
• B Neisseria meningitidis; bilateral adrenal hemorrhagic infarction due to DIC ✓
• C Mycobacterium tuberculosis; caseating granulomatous destruction of adrenal cortex
• D Pseudomonas aeruginosa; adrenal abscess formation

Explanation

Waterhouse-Friderichsen syndrome is characterized by bilateral massive adrenal hemorrhage and infarction, most classically caused by fulminant Neisseria meningitidis septicemia. The pathogenesis involves DIC triggered by bacterial endotoxins (lipopolysaccharide), causing fibrin thrombi in adrenal sinusoids, hemorrhagic infarction, and acute adrenocortical insufficiency, compounding septic shock. The adrenal cortex (which is highly vascular) is selectively vulnerable. TB causes chronic granulomatous adrenal destruction (Addison disease); Pseudomonas causes adrenal abscesses rarely.

Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.

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