Diagnosis
Fever, chills, hypotension an hour or three after treating spirochetes: Lyme, leptospirosis, relapsing fever or syphilis (PubMed). Due to the release of endotoxins as the organisms die.
Epidemiologic Risks
Treating relapsing fever, Lyme, leptospirosis, or syphilis. Were you not paying attention?
"The overall rate of JH reaction was 31.5% (34.6% in HIV-infected patients and 25.2% in HIV-uninfected patients). In multivariate analysis, risk factors for JH reaction included high rapid plasma reagin (RPR) titers, early syphilis, and prior penicillin treatment (PubMed)."
Microbiology
Empiric Therapy
Supportive. Try steroids, fluids, Benadryl® (my one brand name).
Pearls
It was first noticed by Jarisch & Herxheimer when syphilis was treated with mercury
Rants
"Chronic" Lyme patients talk about 'herxing' whenever they get antibiotics. They don't.
Last Update: 10/22/18.