Meteoric effect of meropenem: an unrevealed case report on Jarisch Herxheimer reaction
DOI:
https://doi.org/10.18203/2319-2003.ijbcp20233910Keywords:
Adverse Drug Reaction,, Jarisch Herxheimer Reaction, Meropenem, Syphilis, UrosepsisAbstract
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.
References
O'Byrne P, MacPherson P. Syphilis. BMJ. 2019;365:l4159
Takamizawa S, Gomi H, Shimizu Y, Isono H, Shirokawa T, Kato M. Leptospirosis and Jarisch-Herxheimer reaction. QJM. 2015;108:967-8.
Pimenta D, Democratis J. Risky behavior: a rare complication of an uncommon disease in a returning traveler. BMJ Case Rep. 2013;2013:75.
Gallardo C, Williams-Smith J, Jaton K, Asner S, Cheseaux JJ. Leptospirosis in a family after whitewater rafting in Thailand. Rev Med Suisse. 2015;11:872-6.
Webster G, Schiffman JD, Dosanjh AS, Amieva MR, Gans HA, Sectish TC. Jarisch-Herxheimer reaction associated with ciprofloxacin administration for tick-borne relapsing fever. Pediatr Infect Dis J. 2002;21:571-3.
Hoekstra KA, Kelly MT. Elevated troponin and Jarisch-Herxheimer reaction in tick-borne relapsing fever: a case report. Case Rep Infect Dis. 2011;2011:314.
Nizič T, Velikanje E, Ružić-Sabljić E, Arnež M. Solitary erythema migrans in children: comparison of treatment with clarithromycin and amoxicillin. Wien Klin Wochenschr. 2012;124:427-33.
Tsai M-S, Yang C-J, Lee N-Y, Hsieh S-M, Lin Y-H, Sun H-Y, et al. Jarisch-Herxheimer reaction among HIV positive patients with early syphilis: azithromycin versus benzathine penicillin G therapy. J Int AIDS Soc. 2014;17:18993.
Dhakal A, Sbar E. Jarisch Herxheimer Reaction. 2022. Available at: https://www.ncbi.nlm.nih.gov/ NBK557820/. Accessed on 20 February 2023.
Butler T. The Jarisch-Herxheimer reaction after antibiotic treatment of spirochetal infections: a review of recent cases and our understanding of pathogenesis. Am J Trop Med Hyg. 2017;96(1):46-52.
Thomsen RW, Hundborg HH, Lervang HH. Diabetes mellitus as a risk and prognostic factor for community-acquired bacteremia due to enterobacteria: a 10-year population-based study among adults. Clin Infect Dis. 2005;40:628-31.
Bharucha NE. Infections of the nervous system. Neurology in Clinical Practice. 3rd ed. London: Butterworth-Heinemann; 2000:1334-5.
Adams RD, Victor M, Ropper AH. Principles of Neurology. 7th ed. New York: McGraw-Hill; 2000: 722-8.
Birnbaum NR, Goldschmidt RH, Buffett WO. Resolving the common clinical dilemmas of syphilis. Am Fam Physician. 1999;59:2233-46.
Polsky I, Samuels SC. Neurosyphilis. Screening does sometimes reveal an infectious cause of dementia. Geriatrics. 2001;56:60-2.
Toptan T, Ozdilek B, Kenangil G, Ulker M, Domac FM. Neurosyphilis: a case report. North Clin Istanb. 2015;2(1):66-8.
Yang T, Tong M, Xi Y. Association between neurosyphilis and diabetes mellitus: the resurgence of an old problem. J Diab. 2014;6:403-8.
Friedland IR, Lutsar I. New antibiotics. Curr Opin Pediatr. 1998;10:41-5.
Arrieta A. Use of meropenem in treating serious infections in children: a review of the current literature. Clin Infect Dis. 1997; 24(2):S207-12.
Ayalew K, Nambiar S, Yasinskaya Y, Jantausch BA. Carbapenems in pediatrics. Ther Drug Monit. 2003;25:593-9.
Shah D, Narang M. Meropenem. Indian Pediatr. 2005;42:443-50.
Hellinger WC, Brewer NS. Carbapenems and monobactams: imipenem, meropenem, and aztreonam. Mayo Clin Proc. 1999;74:420-34.
Fish DN, Singletary TJ. Meropenem, a new carbapenem antibiotic. Pharmacotherapy. 1997;17:644-69.
Hurst M, Lamb HM. Meropenem: A review of its use in patients in intensive care. Drugs. 2000;59:653-80.
