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Waterhouse-Friderichsen syndrome (hemorrhagic adrenalitis) is a medical emergency, usually seen in the setting of fulminant meningococcal septicemia, characterized by massive bilateral adrenal hemorrhage and acute adrenal insufficiency. The patients rapidly develop hypotensive shock, disseminated intravascular coagulation, and coma. It is usually fatal within 24 to 48 hrs. in most cases. It is more commonly seen in infants and children; however, cases in adults have been reported. Image courtesy of Dr. Jean-Christophe Fournet, Paris, France; humpath.com; Used with permission