A 32-year-old man is admitted with high fever, hypotensive shock, and purpura fulminans. Blood cultures grow Neisseria meningitidis. At autopsy, both adrenal glands show extensive bilateral hemorrhage. This complication is known as:

• A Addison disease
• B Primary pigmented nodular adrenocortical disease
• C Adrenal metastases
• D Waterhouse-Friderichsen syndrome ✓

Explanation

Waterhouse-Friderichsen syndrome is acute, bilateral adrenal hemorrhage associated with overwhelming bacterial sepsis, classically meningococcemia. It causes acute adrenal insufficiency and shock. Addison disease is chronic autoimmune adrenal destruction without hemorrhage. Adrenal metastases and primary pigmented nodular adrenocortical disease do not cause acute bilateral hemorrhage in the setting of sepsis.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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