Waterhouse Friderichsen Syndrome: Medico-legal issues

The Waterhouse-Friderichsen Syndrome (WFS) is a pediatric emergency characterized by high mortality due to the combination of bilateral adrenal haemorrhage, meningococcal infection and cutaneous purpura. WFS often raises medico-legal problems related to missed or delayed diagnosis mainly related to the short clinical course, the sudden onset of symptoms and unexpected death. We report the death of a 2-year-old child who had no other pathologies. Death occurred quickly about 20 h after the first care visit. The forensic autopsy was ordered following the parental complaint for diagnostic delay in primary care. Clinical data, autopsy and histological findings were consistent for WFS by Neisseria meningitidis (NM) serotype B. Medical malpractice was excluded. WFS has a rapid clinical course. By the time fever and purpura are reported, it may be too late as thrombotic and bleeding complications may already be present.