The Shwartzman reaction: a review including clinical manifestations and proposal for a univisceral or single organ third type

Abstract

The Shwartzman reaction was first described more than 50 years ago and two types, the generalized and the localized, were established in the early 1930s. Studies were mostly related to experimental pathology or immunology, and its significance in clinical medicine was initially obscure though thought to be obstetrically relevant. It is thought that the generalized type has a relation to human disease and that disseminated intravascular coagulation in man is really the counterpart of the generalized Shwartzman reaction in animals. The localized type on the other hand does not have obvious practical clinical pathological significance and tumor necrosis may be the only real example which is commonly seen. Further studies on the Shwartzman reaction relevant to human pathology have, however, suggested that it could be applied to several diseases, the pathogenesis of which was still obscure. The significance seems, however, different from either the generalized or localized type of reaction and so a proposal of the incidence of a third type--'univisceral' or 'single organ' Shwartzman reaction is made. Acute liver necrosis, Waterhouse-Friderichsen's syndrome, haemolytic uraemic anemia, idiopathic pulmonary haemorrhage, acute pancreatitis, acute pituitary necrosis and pseudomembranous colitis all seem to have features suggesting that they could be clinical manifestations of this type of Shwartzman reaction with focal intravascular coagulation.