Waterhouse-Friderichsen syndrome is associated with which condition?

• A. Autoimmune adrenalitis
• B. Tuberculosis
• C. Fungal infection
• D. Waterhouse-Friderichsen syndrome due to meningococcal septicemia

Answer: (D)

Waterhouse-Friderichsen syndrome is an acute adrenal crisis caused by bilateral adrenal hemorrhage in the setting of severe meningococcal septicemia. Neisseria meningitidis in the bloodstream can trigger DIC and hemorrhagic destruction of the adrenal glands, leading to rapid adrenal insufficiency, shock, and purpura. This makes meningococcal septicemia the classic association for this syndrome. Autoimmune adrenalitis, tuberculosis, and fungal infections can cause adrenal insufficiency in other contexts, but they do not produce the acute hemorrhagic adrenal crisis seen with meningococcal sepsis. The statement that links Waterhouse-Friderichsen syndrome to meningococcal septicemia accurately reflects this relationship.