THE WATERHOUSE-FRIDERICHSEN SYNDROME: OBERVATIONS ON ASSOCIATED ADRENAL INSUFFICIENCY AND REPORT OF FOUR CASES

Abstract

4 cases of the Waterhouse-Friderichsen syndrome in adults are reported, and the literature is reviewed. It is unusual to have 4 adult patients with this disease, since 90% of the reported cases have been in children. In 3 of these 4 cases, the responsible organism was detd. by blood culture to be the meningococcus. Adrenal cortical insufficiency in this syndrome is suggested by the clinical pattern of collapse, hypotension, dehydration and vomiting; blood chemistry findings of lowered serum sodium, elevated urea nitrogen, and lowered serum sugar; and pathologic findings of hemorrhage into the adrenal glands. In 2 of these 4 cases, blood chemistry analyses revealed a decrease in the serum Na and an increase in the serum urea N. These two cases were intensively treated with sulfadiazine and adrenal cortex supportive measures (parenteral saline and glucose solns., ACE and DCA acetate) without success. Therapy of this condition should be directed primarily towards the treatment of sepsis, and secondarily towards the correction of possible associated hypoadrenalism. Penicillin is suggested as a very potent therapeutic weapon in combatting the sepsis component of this syndrome, due to its effectiveness against the usual responsible organisms of this disease and to its ability to exert its effect without the usual Jag phase of the sulfon-amides.