title: Elevated CSF cytokines in the Jarisch-Herxheimer reaction of general paresis.
abstract: OBJECTIVE
  The Jarisch-Herxheimer reaction (JHR) is a well-recognized transient worsening of signs and symptoms occurring soon after the first dose of an appropriate antibiotic for several spirochetal infections. The pathogenesis of this reaction is poorly understood. In this case study of cerebrospinal fluid (CSF) cytokines, we aimed to improve understanding of the pathogenesis of JHR in patients with neurosyphilis who develop transient neurologic signs.
  
  
  METHODS
  Four hours after receiving penicillin for general paresis, a 55-year-old man developed a severe JHR characterized by fever, tachycardia, hypertension, obtundation, seizures, and a neutrophilia lasting 18 hours. Cerebrospinal fluid obtained at the peak of the JHR demonstrated a switch from a mild lymphophilia to a moderate neutrophilia. He had markedly elevated CSF interleukin (IL) 8 and likely elevated IL-1β, IL-10, and IL-15 levels, which returned to normal in follow-up CSF examination results.
  
  
  CONCLUSIONS
  To our knowledge, this is the first report of elevated CSF cytokines in a patient with a JHR, which possibly contributed to the neurologic signs of JHR. Further studies on the innate inflammatory response during episodes of acute infection and inflammation are needed to develop targeted therapies to modulate this system, which could, in turn, improve future outcomes and modify the JHR.
authors.affiliation: Department of Neurology Service, New Mexico VA Health Care System, Albuquerque, NM 87108, USA. ledavis@unm.edu
authors.forename: Larry E
authors.initials: LE
authors.lastname: Davis
authors.forename: Ryan
authors.initials: R
authors.lastname: Oyer
authors.forename: J David
authors.initials: JD
authors.lastname: Beckham
authors.forename: Kenneth L
authors.initials: KL
authors.lastname: Tyler
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects; D016207:Cytokines / Q000096:biosynthesis* / Q000134:cerebrospinal fluid*; D005334:Fever / Q000139:chemically induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D009494:Neurosyphilis / Q000150:complications / Q000188:drug therapy* / Q000209:etiology; D010406:Penicillins / Q000009:adverse effects*; D013610:Tachycardia / Q000139:chemically induced; D016896:Treatment Outcome; D014210:Treponema pallidum / Q000187:drug effects / Q000472:pathogenicity
chemical_list: D000900:Anti-Bacterial Agents; D016207:Cytokines; D010406:Penicillins