Jarisch-Herxheimer reaction occurring after penicillin treatment of early syphilis is mediated by:
- A Penicillin IgE-mediated allergic reaction
- B Complement activation by penicillin-treponeme immune complexes
- C Massive cytokine release (TNF-alpha, IL-6, IL-8) from rapid treponemal killing and antigen release ✓
- D Endotoxin release from gram-negative co-infection
Correct answer: C. Massive cytokine release (TNF-alpha, IL-6, IL-8) from rapid treponemal killing and antigen release
Explanation
The Jarisch-Herxheimer reaction is a systemic inflammatory response occurring within 2–8 hours of starting antibiotic therapy for spirochaetal infections (syphilis, Lyme, leptospirosis). It is caused by rapid lysis of treponemes releasing lipoproteins and antigens that trigger macrophages to release TNF-alpha, IL-6, and IL-8, causing fever, rigors, hypotension, and worsening of skin lesions. It is NOT an allergic reaction — antihistamines and adrenaline are not effective; aspirin/hydration is used.
Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.