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Shwartzman (or Shwartzman–Sanarelli) reaction 651 Shwartzman (or Shwartzman–Sanarelli) reaction
Sidney Shulman.
Following the initial or preparatory injection of endotoxin
into the skin, polymorphonuclear leukocytes accumulate
and are then thought to release lysosomal acid hydrolases
that injure the walls of small vessels, preparing them for the
second provocative injection of endotoxin. The intradermal
injection of endotoxin into the skin of a rabbit followed
within 24 hours by the intravenous injection of the same
or a different endotoxin leads to hemorrhage at the local
site of the initial injection. Although the local Shwartzman
reaction may resemble an Arthus reaction in appearance,
the Arthus reaction is immunological and the Shwartzman
reaction is not. In the Shwartzman reaction, the time
between the first and second injections is insufficient to
induce an immune reaction in a previously unsensitized
host. There is also a lack of specificity: different endotoxins
may be used for first and second injections. The generalized
or systemic Shwartzman reaction again involves two
injections of endotoxin; however, both are administered
Localized:
0 Hours
Systemic:
0 Hours
Intradermal LPS
24 Hours
24 Hours
Gregory Shwartzman.
intravenously, one 24 hours following the first. The generalized
Shwartzman reaction is the experimental equivalent of
disseminated intravascular coagulation found in a number
of human diseases. Following the first injection, sparse
fibrin thrombi are formed in the vasculature of the lungs,
kidney, liver, and capillaries of the spleen. The reticuloendothelial
system is blocked, as its mononuclear phagocytes
proceed to clear thromboplastin and fibrin. Administration
of the second dose of endotoxin while the reticuloendothelial
system is blocked leads to profound intravascular
coagulation because the mononuclear phagocytes are
unable to remove the thromboplastin and fibrin. Bilateral
cortical necrosis of the kidneys and splenic hemorrhage
and necrosis are observed. Neither platelets nor leukocytes
are present in the fibrin thrombi that are formed. The
Intravenous LPS
Intravenous LPS Intravenous LPS
Localized and systemic Shwartzman reaction.
Hemorrhagic
necrosis
Disseminated
intravascular
coagulation (DIC)
Bilateral cortical
necrosis of kidneys
and hemorrhagic lesions
in liver, lung and
other viscera
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