Repair After Gangrene Due to Waterhouse-Friderichsen Syndrome

There has been an increase in reports of Waterhouse-Friderichsen syndrome with meningococcic septicemia and with other clinical conditions such as varicella, scarlet fever, and ulcerative colitis.^3-9 The syndrome is well known in pediatric practice, and its mortality was considered very high. Petechial fever, malignant purpuric fever, and spotted fever are synonymous for the rash accompanying meningococcic septicemia. Necrosis of the skin has been reported but is quite rare.¹⁵ Out of 1,518 cases reported from the American 4th Army, only 4 developed skin necrosis and 2 required skin grafting procedures.¹⁴ Hill and Kinney⁸ reported 25 autopsies with several types of skin lesions without skin necrosis. Two survivors developed gangrene of the lower extremities. Lewin⁹ described an infant with gangrene of the face with total loss of the nose requiring complete nasal reconstruction. DeFuccio and Dresner⁴ reported a case of gangrene with amputation of the lower