{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T12:26:01Z","timestamp":1788006361744,"version":"build-2784847793"},"reference-count":18,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,3,11]],"date-time":"2025-03-11T00:00:00Z","timestamp":1741651200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Sepsis can lead to life-threatening complications such as hemophagocytic lymphohistiocytosis (HLH) and bilateral adrenal hemorrhage (BAH), commonly known as Waterhouse-Friderichsen syndrome. HLH involves severe inflammation and organ damage, often linked with infections and autoimmune diseases, while BAH leads to adrenal insufficiency, typically caused by <jats:italic>Neisseria meningitidis<\/jats:italic>, though <jats:italic>Escherichia coli<\/jats:italic> (<jats:italic>E. coli<\/jats:italic>) is a rare cause.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case presentation<\/jats:title><jats:p>A 27-year-old Japanese woman, with a history of diabetes mellitus and obesity, presented with a complicated urinary tract infection. She commenced oral levofloxacin treatment five days before hospital admission. Her medications included prednisolone 5 mg\/day, trimethoprim-sulfamethoxazole for pyoderma gangrenosum, and oral hypoglycemic agents. Upon admission, her vital signs, including body temperature and blood pressure, were stable, and her body mass index was recorded at 49.8. Laboratory tests indicated elevated white blood cell count and C-reactive protein. She was diagnosed with a urinary tract infection and was treated with levofloxacin and trimethoprim-sulfamethoxazole. On day 16 of hospitalization, her general condition rapidly worsened, leading to her sudden death on day 18. Premortem blood tests showed cytopenia, and blood cultures tested positive for <jats:italic>E. coli<\/jats:italic>. Autopsy imaging using computed tomography revealed enlargement and high density of the left adrenal gland. Postmortem pathology identified bilateral adrenal hemorrhages with focal necrosis. Extensive erythrophagocytic macrophages were observed in the bone marrow, spleen, and liver. Disseminated intravascular coagulopathy was confirmed through the detection of a renal glomerular fibrin thrombus.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>We concluded that <jats:italic>E. coli<\/jats:italic> infection had caused multiple fatal conditions, such as disseminated intravascular coagulopathy, bilateral adrenal hemorrhage, and suspected hemophagocytic lymphohistiocytosis leading to the death of the young woman.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2025.1496961","type":"journal-article","created":{"date-parts":[[2025,3,11]],"date-time":"2025-03-11T05:11:26Z","timestamp":1741669886000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Case Report: Bilateral adrenal hemorrhage and hemophagocytosis in the reticuloendothelial system caused by Escherichia coli in a young woman: an autopsy case"],"prefix":"10.3389","volume":"12","author":[{"given":"Yudai","family":"Tanaka","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koji","family":"Hayashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ei","family":"Kawahara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shin-Ichiro","family":"Azuma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maho","family":"Hayashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuka","family":"Nakaya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asuka","family":"Suzuki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Midori","family":"Ueda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rei","family":"Asano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiromi","family":"Hayashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toyoaki","family":"Miura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kouji","family":"Hayashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mamiko","family":"Sato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasutaka","family":"Kobayashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,3,11]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1001\/jama.2016.0287","article-title":"The third international consensus definitions for sepsis and septic shock (Sepsis-3).","volume":"315","author":"Singer","year":"2016","journal-title":"JAMA."},{"key":"B2","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1146\/annurev-pathol-020117-043625","article-title":"Hemophagocytic lymphohistiocytosis.","volume":"13","author":"Al-Samkari","year":"2018","journal-title":"Annu Rev Pathol."},{"key":"B3","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1016\/j.blre.2007.05.001","article-title":"Hemophagocytic syndromes.","volume":"21","author":"Janka","year":"2007","journal-title":"Blood Rev."},{"key":"B4","doi-asserted-by":"publisher","first-page":"601","DOI":"10.3201\/eid0606.000608","article-title":"Hemophagocytic syndromes and infection.","volume":"6","author":"Fisman","year":"2000","journal-title":"Emerg Infect Dis."},{"key":"B5","doi-asserted-by":"publisher","first-page":"655","DOI":"10.2169\/internalmedicine.51.5687","article-title":"Hemophagocytic lymphohistiocytosis in a rheumatoid arthritis patient treated with infliximab.","volume":"51","author":"Oda","year":"2012","journal-title":"Intern Med."},{"key":"B6","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1532\/IJH97.07012","article-title":"Nationwide survey of hemophagocytic lymphohistiocytosis in Japan.","volume":"86","author":"Ishii","year":"2007","journal-title":"Int J Hematol."},{"key":"B7","doi-asserted-by":"publisher","first-page":"756","DOI":"10.1016\/S0929-6646(09)60204-7","article-title":"Spontaneous Escherichia coli meningitis associated with hemophagocytic lymphohistiocytosis.","volume":"105","author":"Chang","year":"2006","journal-title":"J Formos Med Assoc."},{"key":"B8","doi-asserted-by":"publisher","first-page":"2968","DOI":"10.1002\/1097-0142(19841215)54:12","article-title":"Bacteria-associated hemophagocytic syndrome.","volume":"54","author":"Risdall","year":"1984","journal-title":"Cancer."},{"key":"B9","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1056\/NEJM194501042320101","article-title":"The waterhouse-friderichsen syndrome.","volume":"232","author":"D\u2019Agati","year":"1945","journal-title":"N Engl J Med."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1113","DOI":"10.1038\/modpathol.2008.98","article-title":"Adrenal gland hemorrhage in patients with fatal bacterial infections.","volume":"21","author":"Guarner","year":"2008","journal-title":"Mod Pathol."},{"key":"B11","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1186\/s13256-017-1236-0","article-title":"Bilateral adrenal hemorrhage in the background of Escherichia coli sepsis: A case report.","volume":"11","author":"Khwaja","year":"2017","journal-title":"J Med Case Rep."},{"key":"B12","doi-asserted-by":"publisher","first-page":"328","DOI":"10.1016\/j.epsc.2013.09.001","article-title":"Adrenal abscess as a complication of Escherichia coli sepsis in neonates: A case report.","volume":"1","author":"Yokoyama","year":"2013","journal-title":"J Pediatr Surg Case Rep."},{"key":"B13","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1002\/pbc.21039","article-title":"HLH-2004: diagnostic and therapeutic guidelines for hemophagocytic lymphohistiocytosis.","volume":"48","author":"Henter","year":"2007","journal-title":"Pediatr Blood Cancer."},{"key":"B14","doi-asserted-by":"publisher","first-page":"S105","DOI":"10.1016\/j.clml.2017.02.017","article-title":"Diagnostic challenges of hemophagocytic lymphohistiocytosis.","author":"Otrock","year":"2017","journal-title":"Clin Lymphoma Myeloma Leuk."},{"key":"B15","doi-asserted-by":"publisher","first-page":"664","DOI":"10.1016\/S0025-6196(12)65129-5","article-title":"Adrenal insufficiency from bilateral adrenal hemorrhage.","volume":"65","author":"Siu","year":"1990","journal-title":"Mayo Clin Proc."},{"key":"B16","doi-asserted-by":"publisher","first-page":"161","DOI":"10.4065\/76.2.161","article-title":"Adrenal hemorrhage: A 25-year experience at the Mayo clinic.","volume":"76","author":"Vella","year":"2001","journal-title":"Mayo Clin Proc."},{"key":"B17","doi-asserted-by":"publisher","first-page":"355","DOI":"10.1007\/s12519-011-0259-7","article-title":"Adrenal hemorrhage in newborns: A retrospective study.","volume":"7","author":"Mutlu","year":"2011","journal-title":"World J Pediatr."},{"key":"B18","doi-asserted-by":"publisher","first-page":"990","DOI":"10.2169\/internalmedicine.37.990","article-title":"Adrenal hemorrhage associated with Klebsiella oxytoca bacteremia.","volume":"37","author":"Hori","year":"1998","journal-title":"Intern Med."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1496961\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,11]],"date-time":"2025-03-11T05:11:30Z","timestamp":1741669890000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1496961\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,11]]},"references-count":18,"alternative-id":["10.3389\/fmed.2025.1496961"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1496961","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,11]]},"article-number":"1496961"}}