Tumour necrosis factor-alpha and adenosine in endotoxin shock-related cardiovascular symptoms

WE have observed uncontrollable cardiogenic shock as a cardiovascular manifestation of systemic inflammatory response syndrome (SIRS) leading to death in a 62-year-old woman. The diagnosis of SIRS was based on the demonstration of endotoxinaemia, and highly elevated plasma levels of tumour necrosis factor (TNF)-alpha, and interleukin (IL)-10. We suggest that these cytokines may contribute to the terminal SIRS-related arrythmias, impaired myocardial contractility, as well as increased vascular permeability. In addition the increased production of adenosine, a counter-regulatory mediator of inflammation may also play a role in cardiodepression. We suggest a relationship between the action of TNF-alpha, IL-10 and adenosine in the pathogenesis of circulatory symptoms described above.