Postmortem detection of Neisseria Meningitidis in a case of Waterhouse- Friderichsen syndrome from fulminant meningococcal disease in an adult patient

Abstract

Waterhouse-Friderichsen syndrome (WFS) from meningococceal sepsis is a rare life-threatening condition which generally occur during infancy and childhood with a high mortality rate (from 10-30% up to 95%). It is very rare in the adult population, usually with pathological risk factors of invasive meningococcal infection. In such fatalities, the condition may rapidly progress into septic shock and disseminated intravascular coagulation with skin lesions (known as "purpura fulminans") and early recognition and therapy is often difficult owing to the unspecific findings at onset. The purpose of this case report is to present an unusual case of WFS from fulminant meningococceal disease with no meningeal involvement in a previously healthy adult patient, unexpectedly associated with dysmegakaryocytopoiesis findings in bone marrow. The conclusive diagnosis was due to the detection of Neisseria Meningitidis in cerebrospinal fluid despite a postmortem interval of four days and the long cadaver refrigeration.

Waterhouse-Friederichsen syndrome in infants and children (Forensic case series)

“…In the WFS group ages varied between 5 months and 2 years. WFS was more frequent in males (4 out of 5 cases) and in countryside areas with poor socioeconomical status (4 out of 5 cases), similar to other sources [15]. Three of five cases were within the normal range of development and a weight deficit of grade II or III was present in 2 cases.…”

“…In all cases we noticed fever associated with digestive phenomena that have worsened dehydration and precipitated the development of low blood pressure with collapse tendency due to decreased extracellular volume by losses of mineralocorticoids leading to circulatory shock with tachycardia, polypnea, cyanotic extremities and lips associated with pale skin, moist, followed by purpuric syndrome (Table 2). Thus, with the development of generalized purpura, chances of survival are significantly reduced, the death rate rises to 90-95% [15,17].…”

Fatal Waterhouse-Friderichsen syndrome due to Neisseria meningitidis group B in a paediatric patient during the phone consultation era

“…The disease progresses rapidly, has severe outcomes, and can be life-threatening [2]. Waterhouse-Friderichsen syndrome, associated with adrenal insufficiency resulting from bilateral adrenal haemorrhage, is a rare and severe complication observed in patients with meningococcal sepsis [3]. The treatment of invasive meningococcal disease is focused on shock management, antibacterial therapy, and supportive care [4].…”

Fatal meningococcal meningitis in a 2-year-old child: A case report

“…In fatal cases, bacteriological diagnosis may not be straightforward due to postmortem replication and relocation of endogenic microflora. In medicolegal practice, aside from routine autopsy and histopathology, also other diagnostic methods, such as microbiological tests, immunohistochemistry and polymerase chain reaction (PCR), are used to examine body fluids and tissues[1-5].…”