UMEM Educational Pearls

Title: What's the Diagnosis? Case by Dr. Ashley Strobel

Posted: 5/19/2014 by Haney Mallemat, MD
Click here to contact Haney Mallemat, MD

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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