Department of Neurology Service, New Mexico VA Health Care System, Albuquerque, NM 87108, USA.
JAMA Neurol. 2013 Aug;70(8):1060-4. doi: 10.1001/jamaneurol.2013.2120.
The Jarisch-Herxheimer reaction (JHR) is a well-recognized transient worsening of signs and symptoms occurring soon after the first dose of an appropriate antibiotic for several spirochetal infections. The pathogenesis of this reaction is poorly understood. In this case study of cerebrospinal fluid (CSF) cytokines, we aimed to improve understanding of the pathogenesis of JHR in patients with neurosyphilis who develop transient neurologic signs.
Four hours after receiving penicillin for general paresis, a 55-year-old man developed a severe JHR characterized by fever, tachycardia, hypertension, obtundation, seizures, and a neutrophilia lasting 18 hours. Cerebrospinal fluid obtained at the peak of the JHR demonstrated a switch from a mild lymphophilia to a moderate neutrophilia. He had markedly elevated CSF interleukin (IL) 8 and likely elevated IL-1β, IL-10, and IL-15 levels, which returned to normal in follow-up CSF examination results.
To our knowledge, this is the first report of elevated CSF cytokines in a patient with a JHR, which possibly contributed to the neurologic signs of JHR. Further studies on the innate inflammatory response during episodes of acute infection and inflammation are needed to develop targeted therapies to modulate this system, which could, in turn, improve future outcomes and modify the JHR.
Jarisch-Herxheimer 反应 (JHR) 是一种在首次使用适当的抗生素治疗几种螺旋体感染后不久发生的明显的短暂症状和体征恶化。该反应的发病机制尚不清楚。在本项关于脑脊液 (CSF) 细胞因子的病例研究中，我们旨在提高对神经梅毒患者 JHR 发病机制的理解，这些患者会出现短暂的神经体征。
一名 55 岁男性在接受麻痹性痴呆的青霉素治疗 4 小时后出现严重的 JHR，表现为发热、心动过速、高血压、意识障碍、癫痫发作和持续 18 小时的中性粒细胞增多。在 JHR 高峰时获得的脑脊液显示出从轻度淋巴细胞增多到中度中性粒细胞增多的转变。他的 CSF 白细胞介素 (IL) 8 水平显著升高，可能还有升高的 IL-1β、IL-10 和 IL-15 水平，在后续的 CSF 检查结果中恢复正常。
据我们所知，这是首例 JHR 患者 CSF 细胞因子升高的报告，这可能导致了 JHR 的神经体征。需要进一步研究急性感染和炎症期间固有炎症反应，以开发靶向治疗来调节该系统，这反过来又可以改善未来的结果并改变 JHR。
