Infect Chemother.  2009 Oct;41(5):298-300. 10.3947/ic.2009.41.5.298.

A Case of Secondary Syphilis with Jarisch-Herxheimer Reaction Presenting as Hypersensitivity Pneumonit

• Heo JY
• Noh JY
• Kim MJ
• Jo YM
• Choi WS
• Song JY
• Cheong HJ
• Kim WJ

• KMID: 1473657
• DOI: http://doi.org/10.3947/ic.2009.41.5.298

Abstract

Jarisch-Herxheimer reaction (JHR) is a self-limited, acute febrile hypersensitivity reaction that occurs after antibiotic therapy against spirochetes disease. When occurring in the text of syphilis therapy, the JHR begins typically 1-2 hour after the administration of penicillin and is characterized by fever, chills, myalgias, and exacerbation of skin lesions. Rarely, severe JHR can occur in the form of endocarditis, fulminant hepatitis, and hypersensitivity pneumonitis. Recently, we experienced an interesting case of JHR complicated by the hypersensitivity pneumonitis after treating secondary syphilis. Proper differential diagnosis is required to differentiate this reaction from drug-induced hypersensitivity reaction.

Keyword

Syphilis; Jarisch-Herxheimer reaction; Hypersensitivity pneumonitis

MeSH Terms

Alveolitis, Extrinsic Allergic
Chills
Diagnosis, Differential
Endocarditis
Fever
Hepatitis
Hypersensitivity
Penicillins
Skin
Spirochaetales
Syphilis
Penicillins
Syphilis

Figure

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  Figure 1 (A) Before treatment with penicillin, there is no abnormal lesion in both lungs. (B) 12 hours later, Abruptly developed ill-defined nodular and patchy air-space opacities are observed. (C) After 3 days, bilateral nodular and patch opacities are much improved.

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  Figure 2 Chest CT scan shows patchy air-space opacities and diffuse ground-glass opacities in both lungs, suggestive of hypersensitivity pneumonitis.

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