Anatomical, clinical and medico-legal aspects of Waterhouse-Friderichsen syndrome : report of a case

Introduction: Waterhouse-Friderichsen Syndrome (WFS) is a massive, often bilateral, adrenal gland haemorrhage, caused by a sudden meningococcal sepsis, even if this kind of pathological presentation can be caused by other micro-organisms. This syndrome is often found in children, and it is a rare event during adult age. Methods: the Authors report a typical WFS case that reached their attention at the Institute of Legal Medicine of Milan. It is a case of an infant of two months of age who reached an emergency paediatric hospital with hyperpyrexia and vomiting. After a period of observation and a series of negative analysis, he was discharged with an antipyretic prescription. During the night the infant’s conditions got worse, and diffuse petechiae appeared; he reached the emergency hospital again. New analysis were performed, and the bacteriological liquor exam shown a Neisseria meningitidis infection. After a short time, the infant died. Results: the autopsy shown a severe cerebral oedema, lung petechiae and bilateral adrenal glands haemorrhage. The cause of death was adrenal glands apoplexy from meningococcal sepsis (WFS); the diagnosis was later confirmed by post-mortal microbiological analysis. Conclusions: in this case the Authors considered non only the pathogenesis and clinical aspects of WFS, but also a possible professional responsibility in the hypothesis of diagnostic or therapeutic deficiencies, taking into account the difficulties implied in the initial clinical diagnosis.