PURPURA FULMINANS

Necropsy performed in a female infant with a generalized purpuric rash. Internal examination revealed dark red adrenal glands without changes in their size and position. Other organs were slightly congested. There is no evidence of meningitis. This patient exhibited the sudden onset of the Waterhouse-Friderichsen syndrome: cyanotic pallor, petechial rash and...death.

Waterhouse-Friderichsen Syndrome
Waterhouse-Friderichsen syndrome is an acute adrenal insufficiency due to massive haemorrhage into the adrenal gland, more often bilateral, caused by malignant form of meningitis. It occurs in fulminant bacterial infections, due principally to the meningococcus, influenza or colon bacillus.

First described in 1894 by Arthur Francis Voelcker (1861-1946; left) and in 1901 by the British dermatologist Ernest Gordon Graham Little (1867-1950; right).



It was first reported as an entity by Rupert Waterhouse (photo) in 1911, and the subject was comprehensively reviewed in 1918 by the Danish paediatrician Carl Friderichsen.