Waterhouse-Friderichsen syndrome describes adrenal gland failure secondary to a previous adrenal haemorrhage that was caused by severe bacterial infection.

Causes

• Neisseria meningitidis: most common cause
• Haemophilus influenzae
• Pseudomonas aeruginosa
• Escherichia coli
• Streptococcus pneumoniae

The features are those of hypoadrenalism, i.e.:

• lethargy, weakness, anorexia, nausea & vomiting, weight loss
• hyperpigmentation (especially palmar creases), vitiligo, loss of pubic hair in women
• crisis: collapse, shock, pyrexia