TY - JOUR T1 - Waterhouse–Friderichsen syndrome as a result of non-meningococcal infection JF - Journal of Clinical Pathology JO - J Clin Pathol SP - 208 LP - 209 DO - 10.1136/jcp.2003.9936 VL - 57 IS - 2 AU - D Hamilton AU - M D Harris AU - J Foweraker AU - G A Gresham Y1 - 2004/02/01 UR - http://jcp.bmj.com/content/57/2/208.abstract N2 - Waterhouse–Friderichsen syndrome—massive adrenal haemorrhage in the setting of overwhelming clinical sepsis—is usually taken at necropsy to indicate meningococcal infection, and may be the only evidence of this pathogen. This report describes three fatal cases of the syndrome in which the causative organism proved to be a streptococcus. The organisms were detected during routine coroners’ autopsies with histology and microbiological investigations. In two cases, the syndrome followed Streptococcus pneumoniae infection and in a third β haemolytic streptococcus group A. Thus, adrenal haemorrhage alone cannot be taken to indicate meningococcal disease and other pathogens, particularly streptococcus, must be considered. ER -