Shwartzman Reaction in an Hl-a-Identical Renal Allograft

A patient with a normally functioning kidney transplant, received from an ABO and HL-A-identical sibling donor, experienced sudden and irreversible cessation of renal function 22 days after transplantation. Histological examination of the kidneys revealed diffuse intravascular coagulation, but circulating antibodies could not, be detected before or after the transplant was removed, nor could they be eluted from the kidney itself. Skin transplantation from the same donor later confirmed that there had been no major tissue antigen mismatch and revealed no evidence of sensitization from the previos-kidney transplant. The findings are strongly suggestive of a localized Shwartzman reaction precipitated by the presence of gram-negative bacteremia in a patient with an allograft who received steroids.