Question

A patient presents with the rash shown below and is treated with penicillin. Fever, headache, and myalgia develop four hours later. What’s the diagnosis?

Answer

Answer: Jarisch-Herxheimer reaction

• Reaction observed 2-8 hours following antibiotic treatment of syphilis as a result of endotoxin released from dying from organisms; it is not an allergy to penicillin, nor a dose related phenomenon.
• Symptoms may include:
  • Fever / chills / rigors
  • Headache
  • Flushing / Vasodilation
  • Worsening rash
  • Hypotension
• Can occur when following treatment of any stage of syphilis although most commonly occurs following treatment of primary syphilis; also with other illnesses caused by spirochetes (Lyme, Leptospirosis, etc.)
• Reaction is typically self-limiting and treatment is supportive care

References

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