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</div><div><span>Waterhouse-Friderichsen syndrome</span></div></div>
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<article><div id="d-article"><div class="page-info"><div class="page-title"><a name="start" id="start">
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</a><h1 class="with-also" itemprop="name">Waterhouse-Friderichsen syndrome</h1>
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</noscript></div><div class="main"><div id="ency_summary"><p>Waterhouse-Friderichsen syndrome (WFS) is a group of symptoms caused when the adrenal glands fail to function normally. This occurs as a result of bleeding into the glands.</p></div><section><div class="section"><div class="section-header"><div class="section-title"><h2>Causes</h2></div><div class="section-button"><button type="submit" aria-controls="section-1" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-1"><p>The <a test="test" href="./002219.htm">adrenal glands</a> are two triangle-shaped glands. One gland is located on top of each kidney. The adrenal glands produce and release different hormones that the body needs to function normally. The adrenal glands can be affected by many diseases, such as infections like WFS.</p><p>WFS is caused by severe infection with meningococcus bacteria or other bacteria such as:</p><ul><li>Group B streptococcus</li><li><em>Pseudomonas aeruginosa</em></li><li><em>Streptococcus pneumoniae</em></li><li><em>Staphylococcus aureus</em></li></ul></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Symptoms</h2></div><div class="section-button"><button type="submit" aria-controls="section-2" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-2"><p>Symptoms occur suddenly. They are due to the bacteria growing in large numbers inside the body. Symptoms include:</p><ul><li>Fever and chills</li><li>Joint and muscle pain</li><li>Headache</li><li>Vomiting </li></ul><p>The infection with bacteria causes bleeding throughout the body, which causes:</p><ul><li>A rash throughout the body</li><li><a test="test" href="./000573.htm">Disseminated intravascular coagulation</a> in which small blood clots cut off blood supply to the organs</li><li><a test="test" href="./000668.htm">Septic shock</a></li></ul><p>Bleeding into the adrenal glands makes the glands unable to produce enough adrenal hormones. This is called adrenal crisis, and it leads to symptoms such as:</p><ul><li>Dizziness, weakness</li><li>Very low blood pressure</li><li>Very fast heart rate</li><li>Confusion or coma </li></ul></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Exams and Tests</h2></div><div class="section-button"><button type="submit" aria-controls="section-3" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-3"><p>Your health care provider will perform a physical exam and ask about your symptoms.</p><p>Blood tests will be done to confirm a bacterial infection. Tests may include:</p><ul><li><a test="test" href="./003744.htm">Blood culture</a></li><li><a test="test" href="./003642.htm">Complete blood count</a> with <a test="test" href="./003657.htm">differential</a></li><li><a test="test" href="./003652.htm">Blood clotting studies</a></li></ul><p>If your provider suspects the infection is caused by meningococcus bacteria, other tests that may be done include:</p><ul><li><a test="test" href="./003428.htm">Lumbar puncture</a> to get a sample of spinal fluid for culture</li><li><a test="test" href="./003840.htm">Skin biopsy</a> and <a test="test" href="./003760.htm">Gram stain</a></li><li><a test="test" href="./003579.htm">Urine analysis</a></li></ul><p>Tests that may be ordered to help diagnose acute adrenal crisis include:</p><ul><li><a test="test" href="./003696.htm">ACTH (cosyntropin) stimulation test</a></li><li><a test="test" href="./003693.htm">Cortisol blood test</a></li><li><a test="test" href="./003482.htm">Blood sugar</a></li><li><a test="test" href="./003484.htm">Potassium blood test</a></li><li><a test="test" href="./003481.htm">Sodium blood test</a></li><li>Blood pH test </li></ul></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Treatment</h2></div><div class="section-button"><button type="submit" aria-controls="section-4" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-4"><p>Antibiotics are started right away to treat the bacterial infection. Glucocorticoid medicines will also be given to treat adrenal gland insufficiency. Supportive treatments will be needed for other symptoms.</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Outlook (Prognosis)</h2></div><div class="section-button"><button type="submit" aria-controls="section-5" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-5"><p>WFS is fatal unless treatment for the bacterial infection is started right away and glucocorticoid drugs are given.</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Prevention</h2></div><div class="section-button"><button type="submit" aria-controls="section-7" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-7"><p>To prevent WFS caused by meningococcal bacteria, a <a test="test" href="./007602.htm">vaccine</a> is available.</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Alternative Names</h2></div><div class="section-button"><button type="submit" aria-controls="section-Alt" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-Alt"><p>Fulminant meningococcemia - Waterhouse-Friderichsen syndrome; Fulminant meningococcal sepsis - Waterhouse-Friderichsen syndrome; Hemorrhagic adrenalitis</p></div></div></section><section><div class="section sec-mb"><div class="section-header"><div class="section-title"><h2>Images</h2></div><div class="section-button"><button type="submit" aria-controls="section-tnails" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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<li><img src="//medlineplus.gov/ency/images/ency/tnails/2938t.jpg" alt="Meningococcal lesions on the back" title="Meningococcal lesions on the back" class="side-img"/><a href="../imagepages/2938.htm">Meningococcal lesions on the back</a></li>
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<li><img src="//medlineplus.gov/ency/images/ency/tnails/8719t.jpg" alt="Adrenal gland hormone secretion" title="Adrenal gland hormone secretion" class="side-img"/><a href="../imagepages/8719.htm">Adrenal gland hormone secretion</a></li>
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</ul></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>References</h2></div><div class="section-button"><button type="submit" aria-controls="section-Ref" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-Ref"><p>Newell-Price JDC, Auchus RJ. The adrenal cortex. In: Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ, eds. <em>Williams Textbook of Endocrinology</em>. 14th ed. Philadelphia, PA: Elsevier; 2020:chap 15.</p><p>Stephens DS. Neisseria meningitides. In: Bennett JE, Dolin R, Blaser MJ, eds. <em>Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases</em>. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 211.</p></div></div></section>
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<section><div class="section"><div class="section-header"><div class="section-title"><h2>Review Date 8/26/2023</h2></div><div class="section-button"><button type="submit" aria-controls="section-version" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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<div id="section-version" class="section-body"><p>Updated by: Jatin M. Vyas, MD, PhD, Associate Professor in Medicine, Harvard Medical School; Associate in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.</p>
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