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April 1963

Septicemic Adrenal Hemorrhage

Author Affiliations

From the Departments of Pathology and Pediatrics of the Children's Hospital and Children's Hospital Research Foundation, and the University of Cincinnati College of Medicine.; William Margaretten, M.D., Department of Pathology, College of Physicians and Surgeons, Columbia University, 630 W. 168th St., New York 32, N.Y.

Am J Dis Child. 1963;105(4):346-351. doi:10.1001/archpedi.1963.02080040348004

Although adrenal hemorrhage is well known to occur in approximately 3% to 4% of persons infected with Neisseria meningitidis,1 it is not so well appreciated that the lesion may occur with infection due to other organisms.2,3 Adrenal hemorrhage, itself, was formerly considered the cause of circulatory collapse and death in fulminant meningococcemia, and replacement therapy with adrenal cortical steroids was advocated on this basis.4,5 Treatment of acute meningococcemia with corticotropin and steroids, however, has recently been questioned, since adrenal insufficiency has never been demonstrated in such patients and their various thrombotic lesions, including adrenal hemorrhage, may be due to the generalized Shwartzman phenomenon, which is known to be potentiated by adrenal steroids.6-8 The present report is an investigation of the pathogenesis of adrenal hemorrhage associated with infections due to bacteria other than N. meningitidis.

Material and Observations  The necropsy reports of patients dying at the Cincinnati