Waterhouse-Friderichsen syndrome Quiz: Ace Your Exams

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A 21-year-old female is brought to the emergency department by EMS after being found unresponsive in her apartment. An accompanying friend recalls the patient was at home sick for several days. The patient is unable to provide any medical history. Temperature is 38.9°C (102°F), pulse is 130/min, respirations are 22/min, blood pressure is 76/52 mmHg, and oxygen saturation saturation is 93% on room air. Physical examination is notable for a diffuse purpuric rash and cool, clammy skin. The patient’s IV, which was established en route, begins to bleed spontaneously. She is aggressively resuscitated with IV fluids, antibiotics, and peripheral vasopressors without improvement in her clinical status. Initial laboratory findings are demonstrated below:

Which of the following organisms is most likely implicated in this patient’s presentation?

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Gram-negative diplococcus

Gram-negative coccobacilli

Gram-negative rod

Gram-positive spore forming rod

Gram-positive diplococci