Hemorrhagic necrosis that was first demonstrated in rabbits with a two-step reaction, an initial local (intradermal) or general (intravenous) injection of a priming endotoxin (ENDOTOXINS) followed by a second intravenous endotoxin injection (provoking agent) 24 h later. The acute inflammation damages the small blood vessels. The following intravascular coagulation leads to capillary and venous THROMBOSIS and NECROSIS. Shwartzman phenomenon can also occur in other species with a single injection of a provoking agent, and during infections or pregnancy. Its susceptibility depends on the status of IMMUNE SYSTEM, coagulation, FIBRINOLYSIS, and blood flow.

Vasculitis, local or systemic, caused by a two-stage reaction in which a first encounter with endotoxin produces intravascular fibrin thrombi whose clearance results in reticuloendothelial blockade which prevents the clearance of thrombi caused by a second encounter with endotoxin, (or a variety of polyanions, glycogen or antigen/antibody complexes) resulting in tissue necrosis and/or hemorrhage; in pregnancy gram-negative septicemia during delivery or abortion may serve as the first or provocative encounter.