Specimen consists of kidneys, adrenals, pancreas and spleen. The kidneys are dissected to show
the renal arteries and ureters, the renal arteries taking their origin from the aorta. The kidneys show
foetal lobulation and there is an area of subcapsular haemorrhage over the anterior surface of the
left kidney. The adrenals are slightly enlarged and appear dark and friable. The pancreas is normal.
The spleen is hypoplastic. Features are those of bilateral haemorrhagic infarction of the adrenals
or the Waterhouse-Friderichsen syndrome.
The patient, a 7 month old girl, was found dead at home. Her parents had noted a head
cold one week prior to death. This had been associated with pyrexia and cough. One day prior to
death she vomited several times. At postmortem petechiae were present on the forehead and the
cheeks. Postmortem blood culture grew streptococcus pneumoniae. Death was due to
pneumococcal septicaemia complicated by bilateral haemorrhagic infarction of adrenals.