The object of this study was to evaluate the evidence for and against operation of the Shwartzman phenomenon (local or generalized) in meningococcemia. It is based on 52 cases of meningococcus infection seen at the Cincinnati Children's Hospital in a 20 year period. The fatal cases were compared with 152 patients who survived meningococcus infection. Vascular thrombosis appears to be the primary lesion involved in the production of the hemorrhagic lesions of the skin and adrenals in acute meningococcemia. It is suggested that these lesions may be produced by a local Shwartzman phenomenon.
Of special interest is the occurrence of three instances of renal cortical necrosis, such as is seen characteristically in the generalized Shwartzman reaction. Because of the similarity of the lesions found in the fatal cases of meningococcus infection with the Shwartzman phenomenon, and the fact that cortisone is one of the most efficient methods of potentiating the Shwartzman phenomenon, led the authors to question the wisdom of the use of adrenal steroid therapy in fulminating meningococcus septicemia. It was also found that of 156 patients with meningococcus infection, not in shock at the time of admission, there was a mortality of 21% for the patients who received adrenal steroid therapy compared with a 7% mortality in those who did not receive adrenal steroids.
