A 6-year-old boy with fulminant meningococcemia develops sudden shock, disseminated intravascular coagulation, and bilateral flank pain. Autopsy would most likely reveal:

• A Bilateral adrenal cortical adenomas with lipid depletion
• B Bilateral adrenal myelolipomas with marrow elements
• C Bilateral adrenal neuroblastoma with calcification
• D Massive bilateral adrenal hemorrhage with cortical destruction ✓

Explanation

This is Waterhouse-Friderichsen syndrome: overwhelming meningococcal septicemia producing bilateral adrenal hemorrhage, cortical destruction, acute adrenal insufficiency, shock and DIC. It classically affects young children. Cortical adenomas are small benign nodules unrelated to sepsis, neuroblastoma is a malignant tumor of infants presenting as an abdominal mass with catecholamine excess rather than acute collapse, and myelolipomas are asymptomatic benign lesions found incidentally.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.