When the Treatment Strikes Back: A Case Series on Jarisch Herxheimer Reaction in Syphilis

JHR is a rare febrile inflammatory reaction occurring after penicillin injections for spirochetal infections. Its usually mild and self-limiting condition and highly encountered with early syphilis than late syphilis. We present this rare case series of JHR encountered in three patients over a period of one month (March 2020) in Sexually Transmitted Infections (STI) clinic in Tirunelveli Medical College & Hospital. All three cases had high risk behaviour and JHR was seen in early syphilis (2 secondary & 1 early latent), with very high titres of RPR and TPHA positivity, thus proving that increased treponemal burden may be one possible trigger for JHR. The prognosis is so favorable with full recovery following supportive measures. The reaction might mimic disease progression or penicillin hypersensitivity, making differential identification crucial.