Jarisch-Herxheimer reaction during antibiotic treatment of spirochaetal infections

A literature report (2) describes a case of familial leptospirosis after a trip to Thailand, during which river water had been swallowed during rafting. The report concerns a 43-year-old woman who presented to her doctor with headaches, non-bloody, watery diarrhoea, a fever of 39.8 °C with chills, myalgia, arthralgia and abdominal pain. Since typhoid fever was initially suspected, empirical treatment was started with ceftriaxone. Her haemodynamic status subsequently deteriorated and was accompanied by the onset of a transient maculopapular rash and mild conjunctival hyperaemia.

The new symptoms, the history and the haemodynamic instability after the initiation of the treatment with ceftriaxone pointed to a Jarisch-Herxheimer reaction. Leptospirosis was later confirmed by specific laboratory tests. The patient's condition slowly started to improve, and the antibiotic therapy with ceftriaxone was continued without any other measures. The outcome of the Jarisch-Herxheimer reaction was documented as an improvement in her condition (recovering).

Leptospirosis was also diagnosed in the patient's 15-year-old son who was also on the rafting trip in Thailand, and his treatment with meropenem and doxycycline also triggered a Jarisch-Herxheimer reaction.