Studies on the mechanism of the Shwartzman phenomenon.

Rabbit skin which is prepared for the Shwartzman phenomenon by an intradermal injection of meningococcal toxin exhibits, in vitro, a high degree of aerobic glycolysis. This metabolic abnormality is reflected, in vivo, by a measurable increase in the concentration of lactic acid in the prepared skin. Some increase in anaerobic glycolysis also occurs in prepared skin; this is of less degree than the increase in aerobic glycolysis. The respiratory quotient of prepared skin tends to be somewhat higher than that of normal skin, although the oxygen uptake is not significantly altered. Gross hemorrhagic lesions which resemble the Shwartzman phenomenon are produced by the intradermal injection of papain into rabbits which have received an intravenous injection of meningococcal toxin 1 hour previously. Such hemorrhagic reactions are not observed when papain is injected into normal rabbit skin. Similarly, hemorrhagic lesions are produced by the intradermal injection of cysteine and BAL, following an intravenous injection of meningococcal toxin. An hypothesis to explain the Shwartzman phenomenon, which implicates tissue protease in the damage to the blood vessels of the skin, is proposed.