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E-CORRESPONDENCE
Year : 2013  |  Volume : 58  |  Issue : 2  |  Page : 161
Waterhouse-Friderichsen syndrome in an adult patient with meningococcal meningitis


(Formerly Senior Resident), Department of Endocrinology at PGIMER Chandigarh, India

Date of Web Publication5-Mar-2013

Correspondence Address:
Viral N Shah
(Formerly Senior Resident), Department of Endocrinology at PGIMER Chandigarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.108095

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How to cite this article:
Shah VN. Waterhouse-Friderichsen syndrome in an adult patient with meningococcal meningitis. Indian J Dermatol 2013;58:161

How to cite this URL:
Shah VN. Waterhouse-Friderichsen syndrome in an adult patient with meningococcal meningitis. Indian J Dermatol [serial online] 2013 [cited 2019 Sep 22];58:161. Available from: http://www.e-ijd.org/text.asp?2013/58/2/161/108095


Sir,

I read the case report by Sonavane, et al.,[1] and found it interesting, but there are certain lacunae in this case report. The authors reported a 29-year-old-male presenting with signs of meningitis and rash, and they found evidence for meningococi on smear as well as on culture, and there was hypotension and hence, they concluded it as Waterhouse-Friderichsen syndrome.

There is no doubt about meningococcal infection and septic shock, and there is high probability for adrenal insufficiency in this case. Surprisingly, authors have not mentioned about the serum cortisol and short synacthen (ACTH) stimulated cortisol value to prove that the shock (hypotension) is due to adrenal insufficiency and not due to other causes, as there are many causes for hypotension during sepsis. [2] Random cortisol and short synacthen test are must to establish the diagnosis of adrenal insufficiency in critical emergency situation. [3] Furthermore, despite patient being on steroid, there was no improvement and the patient died. Adrenal insufficiency if corrected rapidly should lead to fast improvement in vascular status, which was lacking in this case. Therefore, in absence of cortisol value and short synacthen test, it is premature to label this case as Waterhouse-Friderichsen syndrome. The work of science is to replace dogma and science is not based on presumption but based on evidence and proof. Therefore, I felt this case should be considered as a probable case of Waterhouse-Friderichsen syndrome in absence of definite evidence.

 
   References Top

1.Sonavane A, Baradkar V, Salunkhe P, Kumar S. Waterhouse-Friderichsen syndrome in an adult patient with meningococcal meningitis. Indian J Dermatol 2011;56:326-8.  Back to cited text no. 1
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2.The Merk Manual for health professional. Sepsis and septic shock. Available from: http://www.merckmanuals.com/professional/print/sec06/ch072/ch072a.html. [Last Assessed on 2011 Jul 15].  Back to cited text no. 2
    
3.Bourne RS, Webber SJ, Hutchinson SP. Adrenal axis testing and corticosteroid replacement therapy in septic shock patients-local and national perspectives. Anaesthesia 2003;58:591-6.  Back to cited text no. 3
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