Jarisch-Herxheimer Reaction After Cephalosporin Administration in Syphilis

Abstract

The Jarisch-Herxheimer reaction (JHR) is a well-described entity most commonly occurring after the treatment of syphilis with penicillin. Patients often experience flu-like symptoms, in addition to worsening of cutaneous manifestations of syphilis. Severe reactions are uncommon but may include signs of exaggerated systemic inflammatory response. We report a case of a 33-year-old male with secondary syphilis who was treated with ceftriaxone and subsequently developed fluid-refractory hypotension requiring vasopressor administration and intensive care unit admission. To our knowledge, this is the first report of severe hypotension as a result of JHR in a patient with syphilis who was treated with cephalosporin antibiotics.

A case report on penicillin/co-trimoxazole induced Jarisch Herxheimer reaction in secondary syphilis with human immunodeficiency virus

“…He also tolerated the further administration of ceftriaxone. 7 The other case about JHR in secondary syphilis with eosinophilia by Elias et al reported facial erythema and edema after penicillin administration which was treated with prednisone. 8 In our case, co-trimoxazole administration was stopped and we did not re-challenge co-trimoxazole as the antibiotics were changed to meropenem and tigecycline.…”

Use of ceftriaxone as an alternative treatment method in pregnant women diagnosed with syphilis – a single centre experience

“…The use of ceftriaxone was preferred due to its lower risk of Jarisch-Herxheimer reactions and other complications. There have been isolated cases reported where ceftriaxone has caused Jarisch-Herxheimer reactions, 22 but according to literature data, cross-allergic reactions to ceftriaxone have been observed very rarely. 14 In our clinics, the use of ceftriaxone in pregnant women diagnosed with syphilis as an alternative option has been implemented since 2004.…”