Learn About Waterhouse-Friderichsen Syndrome
Waterhouse-Friderichsen syndrome (WFS) is a group of symptoms that occur when the adrenal glands fail to function normally. This is caused by bleeding into the glands.
Fulminant meningococcemia - Waterhouse-Friderichsen syndrome; Fulminant meningococcal sepsis - Waterhouse-Friderichsen syndrome; Hemorrhagic adrenalitis
The adrenal glands are two triangle-shaped glands. One gland is located on top of each kidney. The adrenal glands produce and release different hormones that the body needs to function normally. The adrenal glands can be affected by many diseases, such as infections like WFS.
WFS is caused by severe infection with meningococcus bacteria or other bacteria such as:
- Group B streptococcus
- Pseudomonas aeruginosa
- Streptococcus pneumoniae
- Staphylococcus aureus
Symptoms occur suddenly. They are due to the bacteria growing in large numbers inside the body. Symptoms include:
- Fever and chills
- Joint and muscle pain
- Headache
- Vomiting
The infection with bacteria causes bleeding throughout the body, which causes:
- A rash throughout the body
- Disseminated intravascular coagulation, in which small blood clots cut off the blood supply to the organs
- Septic shock
Bleeding into the adrenal glands makes the glands unable to produce enough adrenal hormones. This is called an adrenal crisis, and it leads to symptoms such as:
- Dizziness, weakness
- Very low blood pressure
- Very fast heart rate
- Confusion or coma
Antibiotics are started right away to treat the bacterial infection. Glucocorticoid medicines will also be given to treat adrenal gland insufficiency. Supportive treatments will be needed for other symptoms.
Guy's And St Thomas' NHS Trust
Catherine Horsfield practices in London, United Kingdom. Ms. Horsfield is rated as a Distinguished expert by MediFind in the treatment of Waterhouse-Friderichsen Syndrome. Her top areas of expertise are Retroperitoneal Fibrosis, Waterhouse-Friderichsen Syndrome, Retroperitoneal Inflammation, Kidney Transplant, and Pancreas Transplant.
Aurora Family Medicine
Krista Dyreson is a primary care provider, practicing in Family Medicine in Mequon, Wisconsin. Dr. Dyreson is rated as an Experienced provider by MediFind in the treatment of Waterhouse-Friderichsen Syndrome. Her top areas of expertise are Waterhouse-Friderichsen Syndrome, High Cholesterol, Hypertension, and Glucocorticoid-Remediable Aldosteronism.
Aurora Advanced Healthcare, Inc.
Jeffrey Bahr is a primary care provider, practicing in Internal Medicine in Wauwatosa, Wisconsin. Dr. Bahr is rated as an Experienced provider by MediFind in the treatment of Waterhouse-Friderichsen Syndrome. His top areas of expertise are Hypertension, Glucocorticoid-Remediable Aldosteronism, Familial Hypertension, High Cholesterol, and Intrauterine Device Insertion. Dr. Bahr is currently accepting new patients.
WFS is fatal unless treatment for the bacterial infection is started right away and glucocorticoid medicines are given.
To reduce the risk of WFS caused by meningococcal bacteria, a vaccine against the bacteria is available.
Published Date: August 05, 2025
Published By: Jatin M. Vyas, MD, PhD, Roy and Diana Vagelos Professor in Medicine, Columbia University Vagelos College of Physicians and Surgeons, Division of Infectious Diseases, Department of Medicine, New York, NY. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
Auchus RJ, Flück Pandey CE. The adrenal cortex. In: Melmed S, Auchus RJ, Goldfine AB, Rosen CJ, Kopp PA, eds. Williams Textbook of Endocrinology. 15th ed. Philadelphia, PA: Elsevier; 2025:chap 13.
Stephens DS. Neisseria meningitidis. In: Blaser MJ, Cohen JI, Holland SM, et al, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 10th ed. Philadelphia, PA: Elsevier; 2026:chap 216.