KIDNEYS, ADRENALS, PANCREAS & SPLEEN -Waterhouse-Friderichsen Syndrome

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.