The Herxheimer reaction may be defined as an aggravation of pathologic processes in syphilis following the use of antisyphilitic therapy. The reaction manifests itself in various ways. There may be an increase in the intensity of the lesions of the skin and mucous membranes. Gummas may become swollen and ulcerate before improvement is shown. Visceral lesions may react in a similar manner, manifesting themselves by fever, severe nephritis and obstructive jaundice lasting for a week or more. In syphilis of the nervous system, the symptoms may range from a mild cephalalgia to intensely aggravated focal symptoms and paralysis.
As to the nature of the Herxheimer reaction, much difference of opinion exists among different workers. Many believe it is produced by the liberation of endotoxins from Spirochaeta pallida, thereby accentuating the local and general syphilitic manifestations. Ehrlich suggested that the reaction is due to insufficient dosage of arsphenamine, and that instead
HOUGHTON JE. PARALLELISM BETWEEN HERXHEIMER AND KAHN REACTIONS. JAMA. 1927;88(10):719–720. doi:10.1001/jama.1927.02680360031011
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