Advanced International Journal for Research

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Fulminant Meningococcemia Presenting with Bilateral Adrenal Hemorrhage: A Case of Acute Endocrine Collapse.

Author(s) Mr. akumalla Gowtham
Country India
Abstract Abstract
Background: Waterhouse–Friderichsen syndrome (WFS) is a rare, life-threatening endocrine emergency characterized by bilateral adrenal hemorrhage, acute adrenal insufficiency, septic shock, and disseminated intravascular coagulation (DIC), most commonly caused by Neisseria meningitidis. Early recognition and prompt treatment are essential to reduce mortality.
Case Presentation: A 21-year-old male presented with a 24-hour history of high-grade fever, vomiting, generalized weakness, altered sensorium, hypotension, and rapidly progressive purpuric rash. Laboratory evaluation demonstrated leukocytosis, severe thrombocytopenia, hyponatremia, hyperkalemia, hypoglycemia, prolonged PT/INR and aPTT, and markedly reduced serum cortisol, consistent with acute adrenal insufficiency and DIC. The patient was diagnosed with fulminant meningococcemia complicated by Waterhouse–Friderichsen syndrome. Management included aggressive intravenous fluid resuscitation, ceftriaxone, stress-dose intravenous hydrocortisone, vasopressor support, correction of hypoglycemia, and blood component therapy for DIC. The patient required mechanical ventilation for 48 hours and subsequently showed gradual clinical improvement.
Conclusion: This case highlights the importance of maintaining a high index of suspicion for Waterhouse–Friderichsen syndrome in patients presenting with septic shock, purpuric rash, and biochemical evidence of adrenal insufficiency. Early diagnosis, prompt initiation of broad-spectrum antibiotics, corticosteroid replacement, and intensive supportive care are crucial to improve survival and reduce the high mortality associated with this condition.
Keywords Keywords: Waterhouse–Friderichsen syndrome; Fulminant meningococcemia; Bilateral adrenal hemorrhage; Acute adrenal insufficiency; Septic shock; Disseminated intravascular coagulation (DIC); Neisseria meningitidis; Purpuric rash; Hydrocortisone; Ceftriaxone.
Field Medical / Pharmacy
Published In Volume 7, Issue 4, July-August 2026
Published On 2026-07-30
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