Summary
The generalized Shwartzman reaction is a definitive disease process which is the result
of two minor episodes of acute inflammation of the circulating blood. The identifying
feature of the reaction is thrombosis of the micro circulation, specifically of glomerular
capillary thrombosis which persists long enough to cause bilateral renal cortical
necrosis. The reaction is the result of an interplay between leukocytes, platelets,
complement, the contact system, the extrinsic prothrombin activator system, adrenal
glucocorticoids, adrenal catecholamines, alpha - adrenergic receptor sites and the
fibrinolytic enzyme system. The reaction occurs only when these systems are affected
within narrow quantitative limits. It is a model of the effects of bacterial endotoxin
on the blood-vascular system and has important implications for acute inflammatory
episodes of the circulating blood induced by other inflammatory agents such as antigen-antibody
complex and particulate matter.
