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March 17, 1945

FULMINATING MENINGOCOCCEMIA (WATERHOUSE-FRIDERICHSEN SYNDROME)AN UNUSUAL CASE WITH RECOVERY FOLLOWING TREATMENT WITH PENICILLIN

JAMA. 1945;127(11):645-646. doi:10.1001/jama.1945.92860110001007
Abstract

The Waterhouse-Friderichsen syndrome is designated as a symptom complex characterized by purpura and shock associated with the postmortem findings of bilateral adrenal hemorrhage. Karsner1 states that this syndrome may be caused by the streptococcus, pneumococcus or influenza bacillus. Boger2 cites a case in which meningococci were demonstrated by direct examination of the peripheral blood smear. He states that this finding has been recorded as occurring only in fatal cases.

In this case the pathologist demonstrated meningococci in the smear after repeated examinations. Boger's report would indicate that this is the first surviving patient in whom the meningococcus was demonstrated in the peripheral blood smear.

Cosgriff3 states that with the increasing prevalence of meningococcic meningitis there was an associated rise in the number of cases of the so-called Waterhouse-Friderichsen syndrome. He cited 4 adult cases seen in the New

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