Postmortem detection of Neisseria Meningitidis in a case of Waterhouse-Friderichsen syndrome from fulminant meningococcal disease in an adult patient

Waterhouse-Friderichsen syndrome (WFS) from meningococceal sepsis is a rare life-threatening condition which generally occur during infancy and childhood with a high mortality rate (from 10-30% up to 95%). It is very rare in the adult population, usually with pathological risk factors of invasive meningococcal infection. In such fatalities, the condition may rapidly progress into septic shock and disseminated intravascular coagulation with skin lesions (known as “purpura fulminans”) and early recognition and therapy is often difficult owing to the unspecific findings at onset. The purpose of this case report is to present an unusual case of WFS from fulminant meningococceal disease with no meningeal involvement in a previously healthy adult patient, unexpectedly associated with dysmegakaryocytopoiesis findings in bone marrow. The conclusive diagnosis was due to the detection of Neisseria Meningitidis in cerebrospinal fluid despite a postmortem interval of four days and the long cadaver refrigeration.