Delayed Onset of the Jarisch-Herxheimer Reaction in XXXX -Treated Disease: A Case Report and Review of its Histopathology and Implications for Pathogenesis.

@entity1 @entity32 @entity1671 @entity3403 @entity2069 @entity8831 @entity111 @entity5105 @entity56 @entity24553 @entity1909
UNASSIGNED: The Jarisch-Herxheimer reaction (JHR) is a transient @entity32 triggered hours after the start of antibiotic treatment of @entity24553 , namely syphilis. Clinically, JHR manifests as an abrupt onset of constitutional symptoms and exacerbation of cutaneous lesions that resolve without intervention. JHR's pathogenesis is unclear and it is histopathologically rarely reported. Herein, the authors report a 47-year-old @entity1 , with solitary @entity8831 and positive Lyme disease serology, who presented for medical care 14 days after commencement of @entity3403 therapy. She complained of malaise, facial @entity1671 , and acquisition of additional plaques characterized by swelling, @entity5105 , @entity111 , and exfoliative scale. Punch biopsies demonstrated subacute to chronic spongiotic psoriasiform reaction patterns with a superficial lymphocytic infiltrate. By Borrelia-specific immunohistochemistry, spirochetes were found in the deep dermis, unassociated with @entity32 , and focally in the upper spinous layer, associated with spongiosis. @entity2069 DNA was detected by nested polymerase chain reaction. @entity3403 was discontinued, and symptoms and signs resolved within a few days. Liberation of endotoxin-like materials (eg, lipoproteins) from degenerating spirochetes and concomitant cytokine production is the suspected cause of JHR and supported by the finding of lesional spirochetes. Alternatively, a reversal reaction with a @entity56 reaction is also a plausible cause based on spirochetes found in the @entity1909 .
