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Penicillin-induced Jarisch-Herxheimer reaction
Sharon See1, Emilie K Scott, Marc W Levin
1College of Pharmacy and Allied Health Professions, St. John's University, Queens, NY 11439, USA. sees@stjohns.edu
The Annals of Pharmacotherapy
|November 17, 2005
Summary
Jarisch-Herxheimer reaction (JHR) can occur in HIV patients treated for syphilis. This self-limiting reaction, often mistaken for drug allergy, requires supportive care and continuation of antibiotic treatment.
Area of Science:
- Infectious Diseases
- Immunology
- Pharmacology
Background:
- Neurosyphilis is a serious complication of syphilis infection.
- Human Immunodeficiency Virus (HIV) infection can alter the course and presentation of syphilis.
- Early treatment of syphilis, especially neurosyphilis, is crucial.
Observation:
- A case report of a 45-year-old HIV-positive male with presumed neurosyphilis.
- The patient experienced a Jarisch-Herxheimer reaction (JHR) after the first intravenous dose of penicillin G.
- Symptoms included chills, headache, rigors, and tachypnea, resolving within 10 minutes.
Findings:
- The reaction was initially misdiagnosed as a drug allergy but identified as JHR.
- Penicillin was determined to be the likely cause of the JHR.
- JHR is a common, self-limiting reaction to antibiotics used for treponemal infections.
Implications:
- Healthcare providers should anticipate JHR in patients with syphilis, particularly those with HIV.
- Distinguishing JHR from allergic reactions is important for appropriate patient management.
- Supportive treatment, including antipyretics and anti-inflammatories, is recommended for JHR, and antibiotic therapy should be continued.