Two cases are presented in young, apparently healthy patients, who presented with disseminated purpuric symptoms and multiple organ failure that led to death, confirming the presence of Waterhouse Friderichsen syndrome due to adrenal involvement (Figure 1 and Figure 2).

Table 1: Two cases are presented in young, apparently healthy patients, who presented with disseminated purpuric symptoms and multiple organ failure that led to death, confirming the presence of Waterhouse Friderichsen syndrome due to adrenal involvement (Figure 1 and Figure 2).

	Case 1	Case 2
Genre, age	Female, 24-years-old	Male, 42-years-old
Medical history	Apparently healthy	Apparently healthy
Symptoms	Fever, vomiting, disorientation Purple spread 12 hours later	Fever, disorientation, anuric Purple spread 6 hours later
Initial evaluation	Deep shock (80/40 mmHg), metabolic acidosis, multiple organ failure including adrenal and respiratory failure.	Deep shock (88/53 mmHg), metabolic acidosis, multiple organ failure including adrenal and respiratory failure.
Hemoglobin Leukocytes Platelets Creatinine Creatine phosphokinase Bilirubins Transaminases Lactic dehydrogenase Na/K Prothrombin time Partial thromboplastin time Fibrinogen pH, pO₂, pCO₂, HCO₃	12.6 g 9,800 43,000 2.3 mg 5,000 U 1.0 mg/dl 65/70 U 816 U 132/3.2 mmol does not coagulate 78.4 seg does not coagulate 7.06, 87, 37, 10.1	13.2 g 31,900 15,000 6.0 mg 4,000 U 2.2 mg/dl 120/178 U 980 U 128/4.5 mmol 32.6 seg 42.6 seg 480 mg 6.8, 78, 40, 8.2
Isolated pathogen	Staphylococcus haemolyticus	None
Adrenal imaging	Adrenal necrosis	Adrenal necrosis
Evolution and prognosis	Stay in ICU with organic support, broad spectrum antimicrobials, steroids, despite this poor prognosis	Stay in ICU with organic support, broad spectrum antimicrobials, steroids, despite this poor prognosis