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Syphilis is a systemic infection with variable manifestations depending on its clinical stage. Known as “the great imitator”, its management is even more defying when the Jarisch-Herxheimer reaction occurs, which is a self-limited acute febrile reaction that occurs within 24 hours after treatment for a spirochete infection.
The authors describe the case of a 33-year-old man with a secondary syphilis who, three hours after the administration of benzathine benzylpenicillin 2.4 million international units, presents with fever, worsening of the initial cutaneous manifestations, abdominal pain and hepatocellular dysfunction, these last two described as unusual manifestations of this reaction. The authors discuss the pathophysiology of the Jarisch-Herxheimer reaction, its clinical manifestations and management recommendations according to the current evidence.
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