Fatal Waterhouse-Friderichsen syndrome due to Ewingella americana infection

Am J Forensic Med Pathol. 2003 Mar;24(1):41-4. doi: 10.1097/01.PAF.0000051704.91568.A6.


A fatal case of Waterhouse-Friderichsen syndrome resulting from infection in a previously healthy 74-year-old woman is reported. The patient died suddenly within 14 hours after presentation. The diagnosis of Waterhouse-Friderichsen syndrome as the cause of death was established post mortem based on autopsy findings, microscopic examination, measurement of serum procalcitonin concentration (113 ng/ml), and outcome of postmortem bacteriologic cultures that grew in heart and spleen blood samples. Since the introduction of as a new group in the family in 1983, more recent case studies have established its clinical significance and pathogenic potential to cause severe, life-threatening bacteremia and sepsis. is a rare pathogen that should be added to the list of unusual bacteria causing Waterhouse-Friderichsen syndrome.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Calcitonin / blood
  • Calcitonin Gene-Related Peptide
  • Enterobacteriaceae / isolation & purification*
  • Enterobacteriaceae Infections / diagnosis*
  • Enterobacteriaceae Infections / microbiology*
  • Fatal Outcome
  • Female
  • Heart / microbiology
  • Humans
  • Protein Precursors / blood
  • Spleen / microbiology
  • Waterhouse-Friderichsen Syndrome / diagnosis*
  • Waterhouse-Friderichsen Syndrome / microbiology*


  • CALCA protein, human
  • Protein Precursors
  • Calcitonin
  • Calcitonin Gene-Related Peptide