A 4-year-old boy with fulminant meningococcemia develops shock, purpuric rash, and disseminated intravascular coagulation and dies within hours despite antibiotics. Autopsy is expected to show:

• A Bilateral adrenal cortical hyperplasia
• B Adrenal caseating granulomas with calcification
• C Unilateral adrenal adenoma with lipid depletion
• D Bilateral adrenal hemorrhage with cortical effacement ✓

Explanation

Waterhouse-Friderichsen syndrome is overwhelming septicemia, classically meningococcal, producing bilateral massive adrenal hemorrhage that effectively destroys the cortex and precipitates acute adrenal insufficiency. It occurs most often in children and presents with shock, DIC, and rapid death. Cortical hyperplasia suggests congenital adrenal hyperplasia, granulomas suggest tuberculosis, and an adenoma is unrelated to sepsis.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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