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Background: Leptospirosis poses a diagnostic challenge owing to its wide array of symptoms, ranging from asymptomatic cases and febrile syndromes to severe disease with a high mortality rate. Risk factors are associated with exposure and the immune response, particularly in immunosuppressed patients. Case presentation: A clinical case involving a 49-year-old patient with a history of splenectomy and no immunization schedule. The patient presented to the emergency room with non-specific symptoms, primarily myalgias, arthralgias, and emesis, initially suggestive of a viral infection. However, there was a rapid progression to hypoxemic respiratory failure, requiring invasive ventilatory support. Given the immune status due to spleen absence, antibiotic treatment with meropenem and linezolid was promptly initiated, to mitigate the risk of post-splenectomy sepsis. During antibiotic administration, the patient experienced febrile episodes, accompanied by chills, myalgias, and emesis, which gradually decreased in both duration and intensity. Ultimately, the patient exhibited satisfactory progress, successfully underwent extubation, and completed a 7-day antibiotic course. Final reports confirmed positive IgM for Leptospira. Conclusion: Leptospirosis is a global zoonotic disease, displaying a diverse array of manifestations; recognized as a potential cause of undifferentiated fever, often confused with other prevalent tropical infections. The imperative to consider this diagnosis extends beyond the general population to encompass individuals in states of altered immunity. Recognizing and addressing leptospirosis in at-risk populations is crucial, as it can significantly impact the prompt initiation of treatment and, consequently, influence associated mortality rates. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to outline a complete picture of Jarisch-Herxheimer reaction (JHR) in the central nervous system among HIV-negative neurosyphilis patients. Methods: A prospective study cohort of 772 cases with almost all stages of neurosyphilis depicted the features of JHR including occurrence rate, risk profiles, clinical manifestations, medical management and prognosis. Results: The total occurrence rate of JHR was 9.3% (95% CI, 7.3-11.4%), including 4.1% (95% CI, 2.7-5.6%) with severe JHR. The reaction started 5 h after treatment initiation, peaked after 8 h, and subsided after 18 h. Patients with severe JHR experienced a longer recovery time (26 h). Patients with general paresis (OR = 6.825), ocular syphilis (OR = 3.974), pleocytosis (OR = 2.426), or a high CSF-VDRL titre (per log2 titre increase, OR = 2.235) were more likely to experience JHR. Patients with general paresis had an 11.759-fold increased risk of severe JHR. Worsening symptoms included cognitive impairment, mania, nonsense speech, and dysphoria, while symptoms of hallucination, urination disorder, seizures, myoclonus, or aphasia appeared as new-onset symptoms. Neurosyphilis treatment did not need to be interrupted in most patients with JHR and could be reinstated in patients with seizures under supportive medication when JHR subsided. Conclusion: Severe JHR displayed a 4.1% occurrence rate and clinicians should pay particular attention to patients at a higher risk of JHR. The neurosyphilis treatment regime can be restarted under intensive observation for patients with severe JHR and, if necessary, supportive medication should be initiated and continued until the end of therapy. [ABSTRACT FROM AUTHOR]

Leptospirosis is a zoonosis that is related to potential respiratory, renal, neurological, and cardiovascular failure. At present, antibiotics are the recommended treatment, but due to the underlying cause of the disease, they may induce the Jarisch-Herxheimer reaction (JHR) within 24 hours. At the same time, we speculate that JHR may aggravate the natural course of leptospirosis. Considering that there are few available reports on this event, we will share a case of pulmonary hemorrhagic leptospirosis, where antibiotic treatment is suspected to have triggered the JHR. This report is expected to improve clinical attention to the relationship between leptospirosis and JHR.

Congenital syphilis is a serious, disabling, and life‐threatening infection that is transmitted transplacentally from mother to fetus. Early diagnosis is often difficult because affected infants are usually asymptomatic at birth and clinical findings are often subtle and nonspecific. Pemphigus syphiliticus is an early presentation of congenital syphilis which is characterized by fluid‐filled vesicles and bullae which appear mostly on the extremities and tend to rapidly desquamate and erode. Awareness of the clinicians to this early cutaneous manifestation and possible treatment reaction will allow for prompt diagnosis and adequate treatment of syphilis‐infected patients. [ABSTRACT FROM AUTHOR]

The case draws attention to syphilis as a cause of chronic postoperative uveitis following cataract surgery and is the first to document transient worsening of ocular inflammation without systemic symptoms after initiation of treatment, suggesting a localized Jarisch–Herxheimer-like reaction. Case report. The average thickness of the retinal nerve fiber layer was used as an objective measure of intraocular inflammation. The patient's nerve edema worsened during a standard neurosyphilis treatment course and returned to normal several weeks after completion of therapy. Syphilis serologic testing should be strongly considered in the work-up for chronic postoperative uveitis. A localized ocular Jarisch–Herxheimer-like reaction may occur and should not detract from completion of neurosyphilis treatment. [ABSTRACT FROM AUTHOR]

BackgroundLeptospirosis is a widespread zoonotic disease caused by pathogenic Leptospira spp. The treatment of penicillin or tetracycline can cause a Jarisch–Herxheimer reaction (JHR), which can lead to acute respiratory distress syndrome (ARDS) and multi-organ failure in severe cases. The overall course of evolution and imaging features of a JHR exacerbation of leptospirosis have rarely been reported.Case presentationWe present a case of leptospirosis complicated by pulmonary alveolar hemorrhage and a Jarisch-Herxheimer reaction (JHR) that required respiratory and vasopressor support. This case demonstrates a well-defined course of evolution of JHR and the imaging features.ConclusionsLeptospirosis is easily misdiagnosed in some sporadic areas, and JHR complicates its management. Early diagnosis and appropriate treatment can reduce the mortality of severe leptospirosis with JHR.

Leptospirosis, a zoonotic disease characterized by a spectrum of influenza-like symptoms, can manifest as severe cases so called Weil's disease. Early diagnosis and treatment are crucial to avoid the potentially fatal course of the disease. Within 24 hours of the initial administration of antibiotics, patients may experience the Jarisch-Herxheimer reaction (JHR), characterized by chills, fever, hypotension, and impaired consciousness. The Okinawa Prefecture, where our hospital is situated, boasts the highest incidence rate of leptospirosis among all regions in Japan. This reports our encounter with the initial leptospirosis case after a period of 16 years within the Okinawa Prefecture. This case exhibited JHR and required the utilization of noradrenaline (NA). Despite evidence indicating that JHR does not correlate with mortality, we contend that diagnosis of Weil's disease necessitates admission to an intensive care unit (ICU) and vigilant monitoring for JHR, as it may result in impairment of general condition and fatal outcome, as observed in our case. [ABSTRACT FROM AUTHOR]

Yu-Ting Tseng,1,2 Pei-Yun Chou,1 Ming-Hong Tai,2,3 Chia-Yen Dai,4– 6 Susan Shin-Jung Lee,1,7 Yao-Shen Chen,1,7 Hung-Chin Tsai,1,3,7,8,* Yen-Hsu Chen2,6,9– 13,* 1Division of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; 2Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; 3Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan; 4Hepatitis Center and Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; 5Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; 6School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; 7Faculty of Medicine, School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan; 8Department of Parasitology, Kaohsiung Medical University, Kaohsiung, Taiwan; 9Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; 10Sepsis Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan; 11Center of Tropical Medicine and Infectious Diseases, Kaohsiung Medical University, Kaohsiung, Taiwan; 12Department of Biological Science and Technology, College of Biological Science and Technology, National Chiao Tung University, HsinChu, Taiwan; 13Institute of Medical Science and Technology, National Sun Yat-sen University, Kaohsiung, Taiwan*These authors contributed equally to this workCorrespondence: Hung-Chin TsaiDivision of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, TaiwanEmail hctsai1011@yahoo.com.twYen-Hsu ChenGraduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, TaiwanEmail infchen@gmail.comBackground: The Jarisch–Herxheimer reaction (JHR) is an inflammatory reaction that can occur after treatment for syphilis. The mechanism of JHR is unknown. The level of C-reactive protein (CRP) increases during infection and inflammation. We hypothesized that CRP may be involved in the JHR in syphilitic patients at initial syphilis infection and also through interactions with benzathine penicillin-induced phagocytosis.Methods: This prospective cohort study enrolled syphilitic adult patients with/without JHR between July 2018 and October 2020. Serum samples before and after the administration of the first dose of benzathine penicillin were obtained. The serum level of CRP was determined by ELISA. The Kruskal–Wallis test was used to compare the levels of CRP in different groups, and the Wilcoxon signed-rank test was used to compare changes in CRP before and after benzathine penicillin treatment.Results: Twenty-nine syphilitic patients and three control groups (10 men who have sex with men (MSM) taking pre-exposure prophylaxis, 10 HIV-infected patients without syphilis, and 12 HIV-infected patients with previous syphilis) were enrolled. All 29 syphilitic patients were MSM, and 21 patients (72%) were infected with HIV. Overall, 41% (12/29) of the patients developed the JHR. The active syphilis groups had significantly higher serum levels of CRP (median 11,761 ng/mL, IQR 2986– 19,061 ng/mL). There were no significant differences in the serum levels of CRP before or after benzathine penicillin treatment. The 12 patients with the JHR had significantly higher CRP levels before benzathine penicillin treatment (16,262 ng/mL [IQR 12,033– 26,150 ng/mL] vs 3489 ng/mL [IQR 924– 160,640] ng/mL, p = 0.0059, 95% CI 4002– 17,098 ng/mL, area under the curve 0.799, 95% CI 0.632– 0.966, sensitivity 1, specificity 0.647, with a CRP cut-off value of 4569.32 ng/mL).Conclusion: A high baseline CRP level can predict the occurrence of the JHR in syphilitic patients treated with benzathine penicillin.Keywords: C-reactive protein, Jarisch-Herxheimer reaction, syphilis

Tick-borne relapsing fever (TBRF) is caused by spirochetes of Borrelia bacteria. We collected data on all TBRF cases in a TBRF-endemic area in southwest Spain during 1994–2016. We analyzed data from 98 patients in whom TBRF was diagnosed by light microscopy and analyzed the relationship between climatic data and TBRF incidence. Most cases occurred a rural environment during summer and autumn. We describe demographic, epidemiologic, clinical, and analytical characteristics, treatment, and occurrence of Jarisch-Herxheimer reaction. Most patients had fever and headache, and laboratory test results included elevated C-reactive protein, thrombocytopenia, and neutrophilia. No patients died, but 10.1% had Jarisch-Herxheimer reaction. B. hispanica was the infecting species in 12 cases with PCR results. Clinicians often do not suspect TBRF because clinical signs and symptoms vary; therefore, it is likely underdiagnosed, even in disease-endemic areas.

A 39-year-old male patient presented with grossly reduced vision in the left eye for the past three months. Fundus evaluation revealed multiple discrete grayish-white deep chorioretinal lesions in the macular area. An optical coherence tomography (OCT) scan in the affected area was normal. Following investigations, a specific diagnosis of syphilitic macular chorioretinitis was made. A repeat OCT on day eight revealed cystic macular edema, consistent with a Jarisch-Herxheimer reaction (JHR). He was started on oral prednisolone in tapering doses and followed up till resolution. The ocular correlates of JHR are rare, and physicians should be aware of the potential of this phenomenon., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Mehta et al.)

We present a case of middle-aged woman whose health problems began 3 months after a registered tick bite in endemic area of Lyme borreliosis. First symptoms included fatigue, chills, cervical lymphadenopathy, neck pain and stiffness. Patient was afebrile. Lyme disease was excluded due to lack of erythema migrans and negative enzyme immunoassay test results for anti-Borrelia antibodies. During the next few months, her condition was getting worse and symptoms were accompanied with brain fog, dizziness, palpitations, irregular menstrual cycles, insomnia, panic attacks, headaches, and muscle aches. This led to multiple medical tests and examinations, but the diagnosis failed to be established. Finally, after occurrence of paresthesia and weakness of leg muscles, clinical diagnosis of disseminated Lyme borreliosis with nervous system involvement was suspected and antibiotic therapy was initiated. After the second dose of ceftriaxone, patient got fever and her condition worsened. However, ceftriaxone therapy was continued for a total of 5 days and was followed by 4 weeks of doxycycline therapy. Upon completion of antibiotic therapy, high specific anti- Borrelia antibodies were detected by Western blot and SeraSpot. Appearance of anti-Borrelia antibodies, in contrast to negative test results performed immediately before the therapy started, indicated seroconversion. 18 months after the therapy, patient was completely without the symptoms. This paper emphasizes importance of clinical evaluation of Lyme disease and shows a unique case of seroconversion in patient with symptoms of disseminated Lyme disease. Seroconversion was likely triggered by release of lipoproteins and other immunogenic molecules from Borrelia once the bacterial die-off began due to antibiotic therapy. [ABSTRACT FROM AUTHOR]

Introduction: Poorer serologic responses of early syphilis to treatment have been inconsistently reported in HIV-positive patients compared with HIV-negative patients, but the interpretation of previous studies is limited by discrepant study designs. The present study aimed to evaluate the effect of HIV infection on the treatment response to a single dose of benzathine penicillin G (BPG) for early syphilis. Methods: From January 2015 to March 2020, adult patients with early syphilis who received a single dose of BPG were enrolled and rapid plasma reagin (RPR) titers were periodically determined. The primary outcome was serologic response, defined as at least a fourfold decline of RPR titer at 12 months of BPG treatment compared with that at baseline, which was examined in the intention-to-treat (ITT) and per-protocol analyses. Treatment failure included lack of at least a fourfold decline in RPR titers and at least a fourfold increase in RPR titers. Results: We prospectively enrolled 184 HIV-positive and 68 HIV-negative participants with early syphilis, who were all men who have sex with men, with a higher proportion of previous syphilis (70.1%) and early latent syphilis (64.1%) among HIV-positive participants. In the ITT with last-observation-carried-forward analysis, HIV-positive participants had a significantly lower serologic response rate at 12 months of treatment than HIV-negative participants (73.4% vs. 91.2%). Of HIV-positive participants, 12.5% failed to achieve at least fourfold decline in RPR titers and 14.1% had at least a fourfold increase in RPR titers. The factors associated with 12-month serologic response were HIV infection (adjusted odds ratio [AOR] 0.33; 95% confidence interval [CI] 0.13–0.81) and RPR titer (per 1-log2 increase, AOR 1.36; 95% CI 1.23–1.51). Conclusion: HIV-positive patients with early syphilis had poorer serologic responses to BPG treatment than HIV-negative patients during a 12-month follow-up period. [ABSTRACT FROM AUTHOR]

Purpose: To report an intraocular Jarisch-Herxheimer reaction induced by Lemierre syndrome antibiotherapy. Methods: Case report. Results: A 43-year-old-man presented with an acute onset of bilateral blurred vision few days after intravenous antibiotic administration for Lemierre syndrome. Best-corrected visual acuity was 20/32 in both eyes. Examination revealed bilateral cystoid macular edema and peripheral retinal vasculitis, persisting despite Lemierre syndrome recovery with antibiotics. Intravitreal injection of ranibizumab 0.5 mg (0.05 mL) was performed in both eyes. After 1 month, cystoid macular edema and retinal vasculitis were totally resolved, and best-corrected visual acuity increased to 20/20 in both eyes. The paradoxical worsening of the patient's best-corrected visual acuity after initiating antibiotherapy evokes a Jarisch-Herxheimer reaction. The result of this single intravitreal injection of ranibizumab was sustained; best-corrected visual acuity remained unchanged (20/20 in both eyes), and no recurrence of cystoid macular edema or retinal vasculitis was found after 4-year follow-up. Conclusion: To the best of our knowledge, this is the first reported case of an isolated intraocular Jarisch-Herxheimer reaction induced by Lemierre syndrome antibiotherapy and successfully treated with a single intravitreal injection of ranibizumab. [ABSTRACT FROM AUTHOR]

The purpose of this study is to explore whether a correlation exists between the bacterial load of Borrelia persica in tick-borne relapsing fever (TBRF), established by quantitative real-time PCR, and the development of Jarisch-Herxheimer reaction (JHR) after the initiation of antibiotic treatment. Forty-two blood samples were included in our study. The mean bacterial load, as established by real-time PCR, in patients who developed JHR was significantly greater than in those patients who did not develop JHR (443,293 copies vs. 140,598, p = 0.035). Accordingly, real-time PCR may assist clinicians in identifying patients at higher risk of JHR. [ABSTRACT FROM AUTHOR]

Whipple’s disease is a rare chronic infection caused by the actinomycete Tropheryma whipplei. Patients commonly present with gastrointestinal symptoms. We present a case of classic Whipple’s disease complicated by a probable Jarisch–Herxheimer reaction following the initiation of ceftriaxone treatment.

The Jarisch-Herxheimer reaction (JHR) is a shock-like state in response to antimicrobial therapy due to the release of toxins from decomposing microbial bodies. The reaction mainly occurs in patients with spirochetosis, less often in patients with brucellosis, bartonellosis, rickettsiosis, and can be possibly observed in patients with sepsis or meningococcemia. The JHR in children with community-acquired pneumonia has not been previously described. The article provides the author’s own observation of a similar reaction in a child with upper lobe pneumonia associated with amoxicillin treatment and resolved after the administration of prednisolone.

Tick-borne relapsing fever (TBRF) is caused by spirochetes of Borrelia bacteria. We collected data on all TBRF cases in a TBRF-endemic area in southwest Spain during 1994-2016. We analyzed data from 98 patients in whom TBRF was diagnosed by light microscopy and analyzed the relationship between climatic data and TBRF incidence. Most cases occurred a rural environment during summer and autumn. We describe demographic, epidemiologic, clinical, and analytical characteristics, treatment, and occurrence of Jarisch-Herxheimer reaction. Most patients had fever and headache, and laboratory test results included elevated C-reactive protein, thrombocytopenia, and neutrophilia. No patients died, but 10.1% had Jarisch-Herxheimer reaction. B. hispanica was the infecting species in 12 cases with PCR results. Clinicians often do not suspect TBRF because clinical signs and symptoms vary; therefore, it is likely underdiagnosed, even in disease-endemic areas. [ABSTRACT FROM AUTHOR]

Mycobacterium haemophilum is a slow-growing and iron-dependent nontuberculous mycobacterium that can cause cutaneous ulcerations or nodular lesions. The diagnosis of cutaneous M. haemophilum infection is currently extremely rare in Taiwan. An 80-year-old Chinese man taking oral prednisolone for months presented with multiple erythematous as well as indurated and painful nodules over his right forearm. The diagnosis of M. haemophilum infection was confirmed through positive acid-fast staining – a technique used in histopathology and species identification – which was performed using molecular methods. Notably, Jarisch–Herxheimer reaction developed promptly during the antimicrobial therapy. Ideal skin culture conditions and specific molecular identification techniques are required for optimal detection of M. haemophilum. [ABSTRACT FROM AUTHOR]

Introduction: Tuberculosis-associated uveitis remains a diagnostic and therapeutic challenge. After diagnosis of tuberculosis and initiation of anti-tuberculosis therapy for tuberculosis uveitis, the clinical responses are favorable. However, at 4-6 weeks of the therapy, there commonly occurs paradoxical deterioration due to an increase in inflammation which is often accompanied by cystoid macular edema. Thus, adjuvant administration of anti-inflammatory regimen should be considered. For this purpose, systemic and periocular steroids, systemic and intravitreal immunosuppressive agents have been tested. Nevertheless, there is no report in the literature about intravitreal dexamethasone slow-release implants for the treatment of this inflammatory condition.Methods: Case presentation.Results: We presented a tuberculosis uveitis case whose ocular inflammation is partially modified by systemic and periocular steroid injections and then well controlled by the intravitreal dexamethasone implant.Conclusion: Intravitreal dexamethasone implant injection seems to be a safe and potent option for the treatment of macular edema secondary to tuberculosis uveitis. [ABSTRACT FROM AUTHOR]

Jarisch‐Herxheimer reaction (JHR) should be anticipated in treating neurosyphilis with coexistent human immunodeficiency virus (HIV) encephalitis. In that context we have devised a staging classification for JHR. In addition, an illustrative case is provided to emphasize the need to consider the diagnosis of neurosyphilis in HIV patients, and if delineated, to be prepared for a severe JHR. [ABSTRACT FROM AUTHOR]

A case report of Jarisch-Herxheimer (JHR) reaction on a 10th day of Leptospirosis caused by Leptospira Pomona. JHR occurs as a complication of an antibiotic treatment of various spirochetes and may lead to respiratory distress syndrome, renal failure, hepatic insufficiency, and multiple organ failure. This case represents a skin and cardio-vascular form of JHR with no lung involvement. The patient was treated with benzylpenicillin and low dexamethasone doses for 5th day of the disease with a shift to ceftriaxone and high doses of methylprednisolone. The fastest diagnosis of a sporadic zoonotic disease, early start of antibiotic therapy, and adequate doses of corticosteroids are key to the successful treatment of leptospirosis.

Tick-borne relapsing fever (TBRF) is an infection caused by Borrelia spirochetes. In North America, Borrelia hermsii is the most common cause for TBRF. This vector-borne disease is transmitted by Ornithodoros hermsi, a soft-bodied tick found in high altitudes in northwestern United States and southwestern Canada. Once bitten by the tick and infected by B. hermsii, episodes of fever alternating with afebrile periods can occur. A case of TBRF in a pregnant host was complicated by Jarisch-Herxheimer reaction requiring critical care. This case emphasizes the importance of maintaining a high index of suspicion in TBRF. Clinician recognition, diagnosis and treatment of TBRF as well as public awareness of strategies to prevent tick bites should be strengthened. [ABSTRACT FROM AUTHOR]

Jarisch–Herxheimer reaction (JHR) is an acute and self‐limited condition, which commonly occurs after treatment for spirochetal infections. Probably, it corresponds to a transient immunological reaction to endotoxin‐like products released from the microorganism during the therapy. For this reason, JHR may be associated with many other infectious diseases besides syphilis. Here, we report a case of a patient affected by extended cutaneous candidiasis diagnosed by culture examination; a JHR occurred after an accidental overdose of oral fluconazole. [ABSTRACT FROM AUTHOR]

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Syphilis is an infectious disease that is uncommonly encountered in surgical patients. We present a case of severe syphilitic proctitis leading to large bowel obstruction with imaging findings mimicking locally advanced rectal cancer. A 38-year-old man who had sex with men presented to the emergency department with a 2 week history of obstipation. The patient's medical history was significant for poorly controlled HIV. Imaging demonstrated a large mass in the rectum and the patient was admitted to the colorectal surgery service for management of presumed rectal cancer. Sigmoidoscopy demonstrated a rectal stricture and biopsies showed severe proctitis without evidence for malignancy. Given the patient's history and discordant clinical findings an infectious workup was pursued. The patient tested positive for syphilis and was diagnosed with syphilitic proctitis. He underwent treatment with penicillin and although he experienced a Jarisch-Herxheimer reaction, his bowel obstruction completely resolved. Final pathology on the rectal biopsies demonstrated positive Warthin-Starry and spirochete immunohistochemical stain. This case illustrates key aspects in the care of a patient with syphilitic proctitis mimicking an obstructing rectal cancer, including the need for high clinical suspicion, thorough evaluation including sexual and sexually transmitted disease history, multidisciplinary communication, and management of the Jarisch-Herxheimer reaction. Severe proctitis leading to large bowel obstruction is a possible presentation of syphilis, and a high degree of clinical suspicion is necessary to be able to accurately identify the cause. An increased awareness of the Jarisch-Herxheimer reaction following treatment of syphilis is critical to provide appropriate care in this patient population. • Syphilitic proctocolitis can present as obstructing mass mimicking rectal cancer. • A high index of suspicion is needed to correctly diagnosis syphilitic proctocolitis. • Men who have sex with men and patients with HIV are high risk for syphilis. • The Jarisch-Herxheimer reaction occurs within hours of treatment of syphilis. • Warthin-Starry and immunohistochemical stains can identify Treponemal infection. [ABSTRACT FROM AUTHOR]

Jarisch–Herxheimer reaction (JHR) is a focal, local, or systemic reaction, which follows the first dose of antisyphilitic remedy. JHR is a self-limiting reaction. The appearance of secondary syphilitic rashes following injection of benzathine penicillin was not so common nowadays to meet with JHR. Rashes were resolved completely a week after the injection. This case was reported to alert the physicians about the appearance of secondary syphilitic rashes following the antisyphilitic treatment which could be confused with hypersensitive reactions of penicillin. [ABSTRACT FROM AUTHOR]

Purpose: To describe optical coherence tomography angiography (OCTA) features of lesions of tubercular multifocal serpiginoid choroiditis (TB MSC) that developed paradoxical worsening (PW).Methods: In this prospective study, subjects with TB MSC who developed PW upon initiation of anti-tubercular therapy were included. Multimodal imaging was performed using OCTA, enhanced-depth imaging OCT, fluorescein angiography (FA), and indocyanine green angiography (ICGA). Morphologic changes in the retinochoroidal vasculature during progression of TB MSC were assessed on OCTA.Results: Five subjects (4 males, 1 female) were included in the study. PW of the lesions was associated with increased areas of choriocapillaris flow void on en face OCTA in all eyes. The lesions showed partial healing in the center and continuous progression at the active edges. Two eyes showed development of vascular tufts on OCTA as the lesions progressed.Conclusions: OCTA provides high-resolution imaging of progressive choriocapillaris hypoperfusion among TB MSC patients developing PW of the disease. [ABSTRACT FROM AUTHOR]

Background: Leptospirosis is a zoonotic disease known to have wide-ranging clinical manifestations. Despite a number of published case series, culture-confirmed series are few and there is a paucity of data on Jarisch-Herxheimer reaction (JHR) associated with treatment of leptospirosis. Our objective was to describe the clinical and epidemiological factors associated with leptospirosis in an endemic area of Japan, with a focus on the occurrence of JHR, an often unrecognized and likely underestimated phenomenon. Methods: We performed a retrospective observational study of laboratory-confirmed leptospirosis at a single center over a 40-year period. Results: We report 100 leptospirosis cases in 99 patients during the period 1974-2015. Seventy-four cases were diagnosed by culture, representing eight different serovars. JHR was seen in 23 (82%) of 28 cases, including 19 (90%) of 21 cases treated with bactericidal antibiotics compared to 4 (57%) of seven cases with bacteriostatic antibiotics (p=0.08). Conclusions: We found a wide variety of clinical manifestations, epidemiological exposures, and causative serovars of disease in an endemic region of Japan.We also found that JHR occurs frequently, and its recognition may be important for the diagnosis and management of leptospirosis in the early stage when laboratory confirmation is pending. [ABSTRACT FROM AUTHOR]