{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T12:08:26Z","timestamp":1793102906636,"version":"4.5.0"},"reference-count":29,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,1,20]]},"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:p>\n                    Waterhouse-Friderichsen syndrome (WFS), defined as severe adrenal insufficiency due to bilateral adrenal gland haemorrhagic necrosis, occurred in a 59-year-old woman. An underlying serogroup Y\n                    <jats:italic>Neisseria meningitidis<\/jats:italic>\n                    (NM) infection was diagnosed, with a rapid progression to purpura fulminans, disseminated intravascular coagulation and WFS. Intensive treatment including fluid resuscitation, broad-spectrum antibiotic therapy, ventilatory support, platelet and factor replacement were administered. The meningococcaemia in the presence of WFS had a fulminant progression, leading to a fatal outcome within 24 hours of symptom onset. This case details the diagnosis and management challenges of the WFS, a rare complication of NM septicaemia, and describes the identification of a NM serogroup that is rare in Portugal in middle-aged patients.\n                  <\/jats:p>","DOI":"10.1136\/bcr-2020-238670","type":"journal-article","created":{"date-parts":[[2021,2,4]],"date-time":"2021-02-04T20:02:37Z","timestamp":1612468957000},"page":"e238670","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Fatal Waterhouse-Friderichsen syndrome in an adult due to serogroup Y\n                    <i>Neisseria meningitidis<\/i>"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2823-7256","authenticated-orcid":false,"given":"R\u00faben","family":"Carvalho","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, Centro Hospitalar e Universit\u00e1rio de Coimbra EPE, Coimbra, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernando","family":"Henriques","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, Centro Hospitalar e Universit\u00e1rio de Coimbra EPE, Coimbra, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S\u00f3nia","family":"Teixeira","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, Centro Hospitalar e Universit\u00e1rio de Coimbra EPE, Coimbra, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paulo","family":"Coimbra","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, Centro Hospitalar e Universit\u00e1rio de Coimbra EPE, Coimbra, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,2,4]]},"reference":[{"key":"2025082713123432000_14.2.e238670.1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(10)70251-6"},{"key":"2025082713123432000_14.2.e238670.2","doi-asserted-by":"crossref","DOI":"10.3390\/brainsci10030171","article-title":"Neisseria meningitidis induced fatal Waterhouse\u2013Friderichsen syndrome in a patient presenting with disseminated intravascular coagulation and multiple organ failure","volume":"10","author":"Wu","year":"2020","journal-title":"Brain Sci"},{"key":"2025082713123432000_14.2.e238670.3","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200105033441807"},{"key":"2025082713123432000_14.2.e238670.4","first-page":"461","article-title":"A case of Waterhouse-Friedrichsen syndrome","volume":"51","author":"Farber","year":"1944","journal-title":"Can Med Assoc J"},{"key":"2025082713123432000_14.2.e238670.5","first-page":"7518","article-title":"An autopsy case of pneumococcal Waterhouse-Friderichsen syndrome with possible functional asplenia\/hyposplenia","volume":"8","author":"Hata","year":"2015","journal-title":"Int J Clin Exp Pathol"},{"key":"2025082713123432000_14.2.e238670.6","doi-asserted-by":"crossref","DOI":"10.4322\/acr.2019.103","article-title":"The importance of the postmortem interval for the diagnosis of Waterhouse-Friderichsen syndrome by Neisseria meningitidis in a series of forensic cases","volume":"9","author":"Gentile","year":"2019","journal-title":"Autops Case Rep"},{"key":"2025082713123432000_14.2.e238670.7","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000003119"},{"key":"2025082713123432000_14.2.e238670.8","unstructured":"European Centre for Disease Prevention and Control . 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