Similarities in the Mechanisms Determining the Arthus and Shwartzman Phenomena

Abstract

Arthus was the first to show that the intradermal injection of horse serum in appropriately sensitized rabbits resulted in severe hemorrhagic and necrotic lesions in the skin areas injected (1). Later histopathologic studies have indicated that the characteristically severe and extensive tissue damage occurring during the course of the Arthns phenomenon is due to some form of vascular injury (2, 3), but there is little available information as to the mechanism by which this injury is produced.The macroscopic and microscopic appearance of the skin lesions of the Arthus phenomenon show certain striking similarities to those of the Shwartzman phenomenon, and the possibility has been considered that similar mechanisms may be operating in both cases (4, 5). The techniques employed for eliciting the two phenomena are ordinarily quite different; the Shwartzman phenomenon is produced by two injections of an appropriate bacterial endotoxin, one given intradermally and the other given intravenously after an interval of several hours, while the Arthns phenomenon is elicited by a single intradermal injection of antigen in a sensitized animal. It has been shown, however, that under appropriate conditions the Shwartzman phenomenon can be elicited by antigen-antibody interaction in ~ivo (5). have furthermore shown that bacterial products active in eliciting the Shwartzman phenomenon are also capable of greatly intensifying the local tissue damage resulting from repeated intradermal injections of antigen under circumstances leading to the development of the Arthus phenomenon. These demonstrations of the interrelationship between the two phenomena support the concept that the pathogenesis of the skin lesions in both cases may involve certain common factors which have not as yet been clearly defined.Recent studies on the mechanism of the Shwartzman phenomenon (7-9) have shown: (a) that skin areas prepared for this phenomenon exhibit a marked degree of aerobic glycolysis; (b) that this alteration in metabolism is largely due to the exudate polymorphonuclear leucocytes which migrate into such

Platelets and the Shwartzman Phenomenon

“…The intravascular thrombi in the hemorrhagic skin lesion of the local Shwartzman reaction are largely composed of packed white blood ceils and for this reason are often referred to as "leucocyte thrombi" (24,25). Anticoagulants may act only to interfere with leucocyte aggregation by an effect on clotting of plasma.…”

Allergic Inflammation

“…Indeed, they play a major role in the vascular lesions (6,10,11). In the corneal lesions, there was persistence of the antigen-antibody precipitates in animals rendered leukopenic.…”

“…The earliest changes in the Arthus type of allergic inflammation occur at the blood-tissue barrier (1, 2), and are followed by severe vascular changes, ineluding thrombosis and hemorrhage (3)(4)(5)(6). Thus if there are any connective tissue alterations due to direct antigen-antibody interaction in vascular connective tissue, they could not be distinguished from changes secondary to vascular alterations.…”

Role of platelet‐activating factor (PAF) in platelet accumulation in rabbit skin: effect of the novel long‐acting PAF antagonist, UK‐74,505

“…Together with oedema formation, neutrophil infiltration and haemorrhage, platelet accumulation is a characteristic feature of the Arthus reaction (Stetson, 1951;Humphrey, 1955a; Cochrane & Janoff, 1974;Kravis & Henson, 1977). This model of vascular injury is initiated by the local deposition of immune complexes within the vessel wall and previous reports have demonstrated the importance of neutrophils (Humphrey, 1955a;Cochrane & Janoff, 1974;Warren et al, 1989) and complement fragments such as C5a (Cochrane et al, 1970;Cochrane & Janoff, 1974;Lewis & Turk, 1975;Jose et al, 1983;Yeh et al, 1991;Rossi et al, 1992).…”