Jarisch-Herxheimer reaction

Last Updated: 2023-07-07

Author(s): Anzengruber F., Navarini A.

ICD11: -

  • Jarisch 1895
  • Herxheimer 1902

Due to the pronounced infestation of the pathogen in syphilis (syphilis I, syphilis II, syphilis connata praecox), there may be a massive general reaction to therapy with penicillin.

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The decay of a high number of spirochetes releases toxins.

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  • Reduced AZ
  • Fever
  • chills
  • exacerbation of existing syphilis symptomatology

  • Anamnesis
  • Clinical symptoms

  • Rupture of an aortic aneurysm

  • Prednisolone 50 mg i.v. or p.o. approx. 1 hour before penicillin injection
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  • Prednisolone 50 mg i.v. or p.o. approx. 1 hour before penicillin injection
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  1. Belum GR, Belum VR, Chaitanya Arudra SK, Reddy BS. The Jarisch-Herxheimer reaction: revisited. Travel Med Infect Dis. 2013 Jul-Aug;11(4):231-7. 
  2. Butler T. The Jarisch-Herxheimer Reaction After Antibiotic Treatment of Spirochetal Infections: A Review of Recent Cases and Our Understanding of Pathogenesis. Am J Trop Med Hyg. 2017 Jan 11;96(1):46-52. 
  3. Kadam P, Gregory NA, Zelger B, Carlson JA. Delayed onset of the Jarisch-Herxheimer reaction in doxycycline-treated disease: a case report and review of its histopathology and implications for pathogenesis. Am J Dermatopathol. 2015 Jun;37(6):e68.