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ARTICLE |

THE JARISCH-HERXHEIMER PHENOMENON IN LATE SYPHILIS:  Probable Fatal Reactions to Penicillin

VIRGIL SCOTT, M.D.; RICHARD W. MAXWELL, M.D.; JOHN S. SKINNER, M.D.
JAMA. 1949;139(4):217-220. doi:10.1001/jama.1949.02900210023006.
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Since the introduction of arsphenamine the Jarisch-Herxheimer reaction has been a much debated, frequently maligned and little understood phenomenon. In early syphilis, the reaction is characterized by fever with or without an intensification of accompanying visible lesions, the complete reaction occurring within the first twenty-four hours following the administration of an actively antitreponemal agent. In late syphilis fever also occurs, but the clinical manifestations are more varied both in symptoms and in severity depending, probably in large part, on the anatomic site of the lesion(s) and perhaps, on the numbers of Treponema pallidum present. With the advent of penicillin, attention has been refocused on the Jarisch-Herxheimer phenomenon, and alarming, although not fatal, reactions presumably of this type have been reported in neurosyphilis,1 in cardiovascular syphilis2 and in syphilitic primary optic atrophy.3

The purpose of the present report is to record fatalities in 2 patients with late syphilis

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