Multiple Coagulative Defects in a Patient with the Waterhouse-Friderichsen Syndrome
Authors: OSCAR D. RATNOFF
Journal: Annals of Internal Medicine (1962)

Case Reports1 April 1962Multiple Coagulative Defects in a Patient with the Waterhouse-Friderichsen SyndromeOSCAR D. RATNOFF, M.D., WOLFGANG G. NEBEHAY, M.D.OSCAR D. RATNOFF, M.D.Search for more papers by this author, WOLFGANG G. NEBEHAY, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-56-4-627 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThe pathogenesis of the purpuric manifestations of the Waterhouse-Friderichsen syndrome is unknown. The histologic changes in cutaneous ecchymotic areas have seemed inadequate to explain the occurrence of the bleeding. Information concerning blood clotting mechanisms in this syndrome is limited. Cases have been described in which the blood has been incoagulable (1), clotting and bleeding times have been prolonged (2), or deficiencies of platelets (3-7), proaccelerin, or proconvertin (3) have been present; however, these abnormalities may be exceptional, for they have not been observed in many well-studied cases.The possibility that severe alterations in the clotting mechanism may sometimes contribute to...References1. VON RECHENBERG HK: Zur perakuten Meningokokkensepsis (Waterhouse-Friderichsen Syndrome). Deutsch. Med. Wschr. 79: 1208, 1954. CrossrefMedlineGoogle Scholar2. PRATT-THOMASKELLEYGAZES HRWHPC: Fulminating meningococcemia (Waterhouse-Friderichsen syndrome). Southern Med. J. 38: 229, 1945. CrossrefGoogle Scholar3. HUGENTOBLERHOIGNE FR: Meningokokkenmeningitis mit Waterhouse-Friderichsen Syndrome, geheilt unter Cortison and Antibiotica. Schweiz. Med. Wschr. 84: 416, 1954. MedlineGoogle Scholar4. HILLKINNEY WRRD: Cutaneous lesions in acute meningococcemia; clinical and pathologic study. J. A. M. A. 134: 513, 1947. CrossrefMedlineGoogle Scholar5. RASCHKE G: Über eine perakute Pneumokokkensepsis mit doppelseitiger Nebennierenapoplexie und ausgedehnten Hautblutungen (Waterhouse-Friderichsen Syndrome). Derm. Wschr. 135: 112, 1957. Google Scholar6. COSGRIFF SW: The Waterhouse-Friderichsen syndrome: observations on associated adrenal insufficiency and report of four cases. Ann. Intern. Med. 21: 187, 1944. LinkGoogle Scholar7. GORDONSHIMKIN WHMB: Fulminating meningococcemia with purpura, meningitis and focal necrosis of pituitary. J. A. M. A. 123: 147, 1943. CrossrefGoogle Scholar8. RATNOFFMENZIE ODC: A new method for the determination of fibrinogen in small samples of plasma. J. Lab. Clin. Med. 37: 316, 1951. MedlineGoogle Scholar9. QUICK AJ: Clinical application of the hippuric acid and prothrombin tests. Amer. J. Clin. Path. 10: 222, 1940. CrossrefGoogle Scholar10. ALEXANDER B: Estimation of plasma prothrombin by the one-stage method, in The Coagulation of Blood, Methods of Study, ed by Tocantins, L. M., Grune & Stratton, Inc., New York, 1952, p. 89. Google Scholar11. SEIBERTMARGOLIUSRATNOFF RHAOD: Observations on hemophilia, parahemophilia and coexistent hemophilia and parahemophilia: alterations in the platelets and in the thromboplastin generation test. J. Lab. Clin. Med. 52: 449, 1958. MedlineGoogle Scholar12. SISELAVELLEBECKER HSSMR: A method for assay of Stuart factor. Proc. Soc. Exp. Biol. Med. 96: 662, 1957. CrossrefMedlineGoogle Scholar13. RATNOFFVOSBURGH ODGJ: Observations on the clotting defect in amniotic-fluid embolism. New Engl. J. Med. 247: 970, 1952. CrossrefMedlineGoogle Scholar14. DYGGVE H: A case of purpura fulminans with fibrinogenopenia in association with scarlatina. Acta Med. Scand. 127: 382, 1947. CrossrefMedlineGoogle Scholar15. FERGUSONCHAPMAN JHOD: Fulminating meningococcic infections and so-called Waterhouse-Friderichsen syndrome. Amer. J. Path. 24: 763, 1948. MedlineGoogle Scholar16. DONALDSON VH: The effect of plasmin in vitro on clotting factors in plasma. J. Lab. Clin. Med. 56: 644, 1960. MedlineGoogle Scholar17. NIEWIAROWSKIKOWALSKI SE: Un nouvel anticoagulant dérivé du fibrinogène. Rev. Hemat. (Par.) 13: 320, 1958. MedlineGoogle Scholar18. CONLEYRATNOFFHARTMANN CLODRC: Studies on afibrinogenemia; afibrinogenemia in a patient with septic abortion, acute yellow atrophy of the liver and bacteremia due to E. coli. Bull. Johns Hopkins Hosp. 88: 402, 1951. MedlineGoogle Scholar19. MYERSONKOELLE RMWA: Congenital absence of the spleen in an adult. Report of a case associated with recurrent Waterhouse-Friderichsen syndrome. New Engl. J. Med. 254: 1131, 1956. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Cleveland, OhioFrom the Department of Medicine, Western Reserve University School of Medicine, University Hospitals of Cleveland, and the Euclid-Glenville Hospital, Cleveland, Ohio.This study was supported in part by a research grant (H1661C) from the National Heart Institute, National Institutes of Health, U. S. Public Health Service, and in part by a grant from the American Heart Association.Dr. Ratnoff is a Career Investigator of the American Heart Association.Requests for reprints should be addressed to Oscar D. Ratnoff, M.D., Department of Medicine, Lakeside Hospital, Cleveland 6, Ohio. 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