A unique fatal case of Waterhouse–Friderichsen syndrome caus
The Waterhouse–Friderichsen syndrome (WFS), also known as purpura fulminans, is a very uncommon event but with high morbidity and mortality, that can occur in association with a common infection. It is described as acute hemorrhagic necrosis of the adrenal glands, often caused by meningococcal infection and is more frequently observed in the pediatric than the adult population.

In winter 2017, a 40 years-old Caucasian man was conducted to the emergency department of the local hospital in Sicily (Italy) after a facial trauma that caused a wound on the nose. On physical examination, no abnormal findings were found, and cranium computed tomography (CT) was negative. The wound was sutured and the patient was discharged. After 2 days, the subject returned to the hospital for a state of unspecific general malaise, and then was transferred to the emergency department where the clinicians observed a neurological impairment (Glasgow Coma Scale: 10) state.

Laboratory investigations showed severe hypoglycemia (18 mg/dL), a high anion gap metabolic acidosis; and a glucose-bicarbonate solution was infused. After a few hours, the clinical picture worsened: the man was appearing confused, with the blood pressure of 80/40 mm Hg, heart rate of 96 b/min, oxygen saturation of 96%.

Source: Medicine: August 2019

Read more: https://journals.lww.com/md-journal/Pages/articleviewer.aspx?year=2019&issue=08230&article=00008&type=Fulltext#pdf-link
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