Abstract
We report a case of rapidly progressing septic shock in a previously healthy infant, who was suspected to have Waterhouse-Friderichsen syndrome (WFS) on the basis of a CT scan. A comatose 6-month-old infant was brought to our hospital after losing consciousness. We first diagnosed him with hypoxic brain damage from the clinical course and radiographic evidences, and started treatment of therapeutic hypothermia despite metabolic acidosis. However, the patient's condition, including his hemodynamic status and laboratory data, worsened 8 hours after admission. We then diagnosed him with disseminated intravascular coagulation and severe sepsis, stopped hypothermic management and administered antibiotics. A re-evaluation by contrast enhanced whole body CT was performed to determine the etiology, which revealed hemorrhage from bilateral adrenal glands. We suspected WFS and provided multidisciplinary intensive care including steroids. He died 29 hours after ICU admission due to multiple organ dysfunction syndrome despite intensive treatment against septic shock and adrenal insufficiency. This case underscores the importance of clinical diagnosis of infection in infants. This case also highlights the importance of judicial consideration of the application of therapeutic hypothermia. We should first suspect severe infectious disease from the evidence of metabolic acidosis of unknown cause and reconsider indications for therapeutic hypothermia.
