Infectious Diseases

Question 1

A patient with lymes disease is started on doxycycline he returns to ED 12hrs after first dose with facial flushing, tachycardia and slightly low BP. What is the likely cause?

Answer 1

Jarisch Herxheimer reaction
Can occur in 15% of pts with lyme disease. Caused by abx kicking in and toxins being removed from system.
A sudden and typically transient reaction that may occur within 24 hours of being administered antibiotics for an infection by a spirochete, including syphilis, leptospirosis, Lyme disease, and relapsing fever.
Features: fever, chills, shivers, nausea, headache, tachycardia, hypotension, tachypnoea, flushing of skin, muscle aches, and worsening of skin lesions. It may sometimes be mistaken as an allergy to the antibiotic.

Treat with NSAIDS, IVI, monitoring and supportive measures