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Waterhouse-Friderichsen Syndrome — SCE Infectious Diseases MCQ

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HardInfection Prevention & ControlWaterhouse-Friderichsen SyndromeSCE Infectious Diseases

A 65-year-old man with a history of splenectomy for trauma 30 years ago develops sudden onset high fever, shock, and DIC. Blood cultures subsequently grow a non-typeable Haemophilus influenzae. Despite aggressive resuscitation, he dies within 12 hours. Post-mortem shows bilateral adrenal haemorrhage. What is this syndrome?

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Correct answer: C — Waterhouse-Friderichsen syndrome (bilateral adrenal haemorrhagic necrosis in overwhelming sepsis)

Waterhouse-Friderichsen syndrome is bilateral adrenal haemorrhagic necrosis occurring in the context of overwhelming sepsis, classically meningococcal but also seen with other encapsulated organisms (H. influenzae, S. pneumoniae) in asplenic patients. It causes acute adrenal insufficiency compounding septic shock. This case illustrates the devastating consequences of OPSI in unvaccinated, non-prophylaxed asplenic patients. It reinforces the importance of lifelong penicillin prophylaxis and vaccination in asplenia.

Reference: UKHSA 2024 – Green Book Ch 7: Asplenia; NICE 2024 – Asplenia management