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A case of Jarisch-Herxheimer reaction in candidiasis treated with systemic fluconazole

Marta Muscianese1, Francesca Magri1, Giulia Pranteda2

  • 1Department of Dermatology, La Sapienza University, Rome, Italy.

Dermatologic Therapy
|February 6, 2020
PubMed

Insights

The Jarisch-Herxheimer reaction (JHR) can occur in infections beyond syphilis. This case shows a JHR developing after fluconazole overdose in a patient with extensive cutaneous candidiasis.

Area of Science:

  • Medical Mycology
  • Immunology
  • Dermatology

Background:

  • The Jarisch-Herxheimer reaction (JHR) is typically associated with the treatment of spirochetal infections.
  • It is understood as a transient immunological response to microbial products released during therapy.
  • JHR has been observed in various infectious diseases, not exclusively syphilis.

Observation:

  • A patient presented with extensive cutaneous candidiasis, confirmed by culture.
  • The patient accidentally received an overdose of oral fluconazole.
  • Following the overdose, the patient experienced a Jarisch-Herxheimer reaction.

Findings:

  • This case report documents an unusual occurrence of JHR.
  • The reaction was observed in the context of treating a fungal infection (candidiasis) with fluconazole.
  • The event suggests a potential link between JHR and antifungal treatment under specific circumstances.

Implications:

  • The findings expand the known spectrum of conditions associated with JHR.
  • This case highlights the importance of considering JHR in patients with severe infections experiencing acute febrile reactions during treatment.
  • Further investigation may be warranted to understand the mechanisms underlying JHR in fungal infections and with antifungal agents.
Keywords:
Jarisch-Herxheimer reactioncandidiasisfluconazole

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