Case 1, image 1: This 3 month old baby died of meningitis and autopsy demonstrated bilateral hemorrhage of the adrenal glands in addition to discoloration and inflammation of the meninges.
Case 1, image 2: There is extensive cortical and medullary hemorrhage within the adrenal glands.
Adrenal hemorrhage, abscesses or granulomas may arise during bacterial infections. The most common cause of bilateral adrenal hemorrhage (Waterhouse-Friderichsen syndrome) is Neisseria meningitides, however, many other organisms may also present similarly including Haemophilus influenzae, Streptococcus pneumoniae, Staphylococcus aureus, group A streptococcus, Neisseria gonorrheae, Pseudomonas aeruginosa, and Klebsiella oxytoca. Septic shock mediated by endotoxins is the most common clinical presentation in those with infectious adrenal hemorrhage.
It is important to remember that adrenal hemorrhage may also have noninfectious causes including postoperative state, thromboembolic diseases, treatment with anticoagulants, trauma and burns (Guarner 2008).
Guarner J, et al. Adrenal gland hemorrhage in patients with fatal bacterial infections. Modern Pathology (2008) 21, 1113–1120