Development of Waterhouse–Friderichsen syndrome after infection with SARS-CoV-2 against the background of comorbidity

Abstract

BACKGROUND: The COVID-19 pandemic has also affected rheumatic diseases. A clinical case of the development of Waterhouse–Friderichsen syndrome after SARS-CoV-2 infection in a patient with secondary AA adrenal amyloidosis is presented. CLINICAL CASE DESCRIPTION: Patient G., 57 years old, was hospitalized for several hours on May 20, 2023 at the Cheboksary Regional Hospital with the following diagnosis: “Severe viral interstitial pneumonia. Secondary AA adrenal amyloidosis. Acute adrenal insufficiency”. She was admitted with complaints of a febrile temperature up to 38.2°C. Computed tomography of the chest organs showed signs of bilateral viral interstitial pneumonia (the percentage of lung damage was 74%). The diagnosis of COVID-19 was based on a positive polymerase chain reaction test performed on nasopharyngeal swabs. The blood pressure was 80/40 mm Hg, D-dimer 786 ng/ml (with the normal values of not higher than 243 ng/ml). Despite the treatment, the patient died. An autopsy revealed dystelectasis, hyaline membranes, intraalveolar edema in the lungs, and the deposition of amyloid masses, foci of necrosis of the cortical layer and hemorrhage in the adrenal glands. Signs of disseminated intravascular coagulation syndrome were found. CONCLUSION: The peculiarity of the case is the development of Waterhouse–Frideriksen syndrome without signs of sepsis.

Keywords

• covid-19
• pneumonia
• hemorrhages
• necrosis
• adrenal glands
• disseminated intravascular coagulation syndrome