Jarisch-Herxheimer reaction in a patient with neurosyphilis.

Zifko, Udo; Lindner, K; Wimberger, D.; Volc, B; Grisold, Wolfgang

doi:10.1136/jnnp.57.7.865

Cited by 29 publications

(34 citation statements)

References 20 publications

(2 reference statements)

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“…JHR seen in syphilitic patients is known to have two forms: one is related to constitutional symptoms including fever, myalgia, and headache (asymptomatic type), and the other is related to the exacerbation of psychological symptoms or other neurological signs (symptomatic type) [5]. In the patient discussed here, constitutional symptoms and SE were observed within a day after penicillin administration, which was consistent with symptomatic JHR.…”

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confidence: 62%

“…Considering the findings that pre-existing cortical lesions were exacerbated significantly after treatment, the worsening of cortical lesions might be caused by JHR. SE due to JHR has been reported only in patients with general paresis [1][2][3][4][5]. According to previous reports, pathological findings in parenchymatous neurosyphilis are characterized by inflammatory meningeal thickening and cerebral cortical atrophy [6].…”

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confidence: 99%

“…In patients with syphilis, Jarisch-Herxheimer reaction (JHR) usually occurs within 24 h after antibiotic treatment [5]. Although status epilepticus (SE) due to JHR has been reported in some patients with neurosyphilis [2, 3], neuroradiological findings related to JHR have not been well described.…”

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Deterioration of MRI findings related to Jarisch–Herxheimer reaction in a patient with neurosyphilis

et al. 2010

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Syphilis is a systemic infection that can involve the central nervous system at any stage. In patients with syphilis, Jarisch-Herxheimer reaction (JHR) usually occurs within 24 h after antibiotic treatment [5]. Although status epilepticus (SE) due to JHR has been reported in some patients with neurosyphilis [2, 3], neuroradiological findings related to JHR have not been well described. Here we report the case of a patient with parenchymatous neurosyphilis who developed SE due to JHR, which was accompanied by deterioration of MRI findings in the acute phase of the reaction.A 48-year-old man presented with simple partial seizures 4 months before admission to our hospital. The seizures were well controlled by carbamazepine in the local hospital. He was admitted to our hospital with gradually worsening unsteady gait for a 2 weeks duration. On neurologic examination, homonymous hemianopia of the left lower quadrant, anisocoria, and truncal ataxia were observed.Neuropsychological examination showed impaired memory and attention; he was HIV negative. Cerebrospinal fluid (CSF) examination showed a mononuclear WBC count of 26/mm 3 with elevated total protein levels (70 mg/dL). There were no atypical cells in CSF. Rapid plasma reagin (RPR) and fluorescent treponemal antibody absorption (FTA-ABS) titers in the serum and the CSF were positive (serum RPR 1:16, serum FTA-ABS 1:1,280, CSF RPR 1:8, CSF FTA-ABS 1:1,024). MRI of the brain showed hyperintense lesions on T2-weighted images in the frontal, temporal, and occipitoparietal lobes; corpus callosum; and cingulate gyrus (Fig. 1a). The cerebral cortices in these lesions were partially enhanced on contrast-enhanced T1-weighted images (Fig. 1d, g). Consequently, a diagnosis of parenchymatous neurosyphilis was made, and the patient was started on a treatment with intravenous penicillin G at a dose of 24 million units daily for 2 weeks. However, the patient developed chills and fever 7 h after initiation of treatment, and these constitutional symptoms were followed by nuchal rigidity and fluctuations of consciousness. Subsequently, 16 h after treatment, the patient developed continuous seizures of the right upper extremity with severely impaired consciousness. The condition was diagnosed as developing complex partial SE. Repeat MRI study showed that pre-existing hyperintense lesions on T2-weighted images were enlarged in the frontal lobes (Fig. 1b). Furthermore, intense cortical enhancement in the frontal lobes, left occipitoparietal lobe, cingulate gyrus, and insula was demonstrated (Fig. 1e, h). Intravenous methylprednisolone (250 mg/day for a day) was administered on the day following commencement of the new set of symptoms. The seizures were well controlled with carbamazepine. Although visual field deficits persisted, unstable gait and cognitive dysfunction were significantly improved. Contrast enhancement in the cerebral cortices

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Deterioration of MRI findings related to Jarisch–Herxheimer reaction in a patient with neurosyphilis

et al. 2010

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“…Although paretic neurosyphilis clinically projects as an organic psychosis or dementia, it has recently been accepted to be one of the rare aetiological reasons for dementia (Brooke, et al, 1987;Mahmoudi, et al, 2006). Jarisch-Herxheimer reaction (JHR) might be seen as characterized by clinic status worsening and occasionally psychotic symptoms as an inflammatory response after the start of penicillin treatment, which may not be considered by the professionals (Zifko, et al, 1995). In this report, we present a neurosyphilis case that has had clinical symptoms of a dementia and JHR because of intravenous penicillin treatment that has improved with olanzapine treatment.…”

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confidence: 88%

Olanzapine treatment in Jarisch-Herxheimer reaction due to neurosyphilis with dementia: a case report

et al. 2008

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“…JHR is an immunologic reaction that is often seen when treating patients with spirochaetal infection (20). The incidence rate of JHR in patients with neurosyphilis has been reported in about less than 10% (21); however, the reaction may lead to exacerbation of neurologic symptoms (22).…”

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Neurosyphilis Is a Long-forgotten Disease but Still a Possible Etiology for Dementia

et al. 2015

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We herein report a heterosexual Japanese man in his forties who had been suffering from advanced dementia and personality change for 4 years. Positive results of a serological test for syphilis, Treponema pallidum hemagglutination assay, and fluorescent treponemal antibody-absorption test of both serum and cerebral spinal fluid led to the diagnosis of neurosyphilis. Jarisch-Herxheimer reaction was seen shortly after the first dose of penicillin was administered to the patient. His cognitive function did not recover after treatment. The incidence of syphilis has been reported to be increasing. Neurosyphilis should not be overlooked as an etiology for progressive dementia even in this post-antibiotic era.

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Jarisch-Herxheimer reaction in a patient with neurosyphilis.

Cited by 29 publications

References 20 publications

Deterioration of MRI findings related to Jarisch–Herxheimer reaction in a patient with neurosyphilis

Deterioration of MRI findings related to Jarisch–Herxheimer reaction in a patient with neurosyphilis

Olanzapine treatment in Jarisch-Herxheimer reaction due to neurosyphilis with dementia: a case report

Neurosyphilis Is a Long-forgotten Disease but Still a Possible Etiology for Dementia

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