Meteoric effect of meropenem: an unrevealed case report on Jarisch Herxheimer reaction

Abstract

Jarisch Herxheimer Reaction is an immune mediated, self- limited reaction that releases endotoxins from the spirochetes. It occurs due to an acute inflammatory response when lipoproteins, owing to their entry into the patient's bloodstream, cause an increase in inflammatory cytokines during the period of exacerbation, resulting in body aches, fevers, rashes, nausea and vomiting, and flushing, along with other symptoms. These symptoms usually begin within 2 hours after the administration of the antibiotics. We represent a 76-year-old male patient who has had a known case of recurrent urinary tract infections since 2017 and was recently diagnosed with urosepsis and syphilis after being administered an injection of Meropenem, wherein he developed a Jarisch Herxheimer Reaction. The causality assessment revealed a Naranjo score of 7, indicating a probable adverse drug reaction. This patient was treated with intravenous antihistamines and corticosteroids for its management. Benzathine penicillin was avoided owing to the previous suspected Jarisch Herxheimer Reaction. None of the studies reported that Meropenem could contribute to such a reaction. All healthcare professionals should maintain a high alert of suspicion and be aware of antibiotic induced Jarisch Herxheimer Reaction symptoms and their management to avoid life threatening conditions.