Saturday 15 May 2010

Jarisch-Herxheimer Rxn

You get a 30 year old female patient, with classic presentation of secondary syphillis (condyloma lata, mucuous patches in mouth), whom you treat with IM penicillin.

Six hours later, the woman is back, feverish, complaining of chills, malaise, headaches and myalgia. You check and find that she's tachycardic and mildly hypotensive.

what do you do?

NOTHING :) Yeap, you read that right. Nothing.

Your patient is just experiencing the Jarisch-Herxheimer reaction, which consists of fever, chills, mild hypotension, headache, and increase in intensity of mucucutaneous lesions 2 hours after initiating treatment of syphillis with penicillin. These symptoms usually subside within 12-24 hours without any treatment.

This reaction occurs in 50% of patients being treated for primary syphillis and 90% of patients with secondary syphillis.

Interestingly, this reaction also occurs after treatment of other spirochetal diseases (eg: relapsing fever caused by Borrelia recurrentis). It is thought that this symptom complex is produced by release of treponemal lipopolysaccharides.

So, the next time you get a patient that comes in with these symtpoms after you tried treating them for syph, don't panic! You did nothing wrong.

*of course don't brush off your patient's symptoms if they include: diffuse rash, wheals, angioedema, wheezing, because don't forget: penicillin can cause allergies in individuals sensitive to it!!

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