• This is a real case of Waterhause-Friderichsen (WF) Syndrome.
• Below is a picture of what Ms. BB's adrenal glands probably look like.

• The endothelial cells are the real target of the N. meningitidis organism.
• Here's how the trouble begins.

• The infection starts as a meningiococcal pharyngitis.
• In some people this is followed by a meningiococcemia (blood distribution).
• Because of the endothelial cell invasion and vascular destruction, we see
• Colonization of the CSF, and
• Diffuse hemorrhages, including hemorrhagic necrosis of the adrenal glands.
• This is life-threatening. Without prompt medical treatment Ms. BB will die.
• Antibiotic therapy, fluids for shock and importantly,
• Prompt replacement of steroids because she has no adrenals left.

What happened to Ms. BB?                                                                        Back