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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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