Case Report of Herxheimer Reaction after Autologous Peripheral Blood Stem Cells Infusion

The Jarisch-Herxheimer reaction (JHR) is a transient immunological response that may occur after the initiation of treatment for any type of viral, bacterial or fungal infection such as syphilis, lime disease or Candida albicans. The reaction is similar to the systemic inflammatory response syndrome (SIRS) and characterized by shaking, joint pain, muscle aching, chills, fever, headache, sore throat, malaise, myalgia, tachycardia as well as exacerbation of existing cutaneous lesions such as worsening inflammatory reaction at the sites of localized infection. The reaction generally occurs six to eight hours after treatment beginning with penicillin or other antibiotics and it may be easily confused with a SIRS. The intention of this definition is to outline a clinical response to a nonspecific insult of either infectious or noninfectious origin. The mechanism underlying patho-physiological response remains elusive for modern medicine since it was described over a century ago. An increase in the incidence of JHR may be expected among patients co-infected with HIV and other infectious diseases including HCV and HCB. In this paper we collected a number of patients underwent autologous peripheral blood stem cell transplantation that developed JHR during the first phase of the treatment. As this matter has received very limited attention in recent researches and clinical approaches apart from brief remarks in manuals, we felt significant to provide an overview of its various attributes including the current concepts in pathophysiology and management during clinical stem cell treatment and not only following conventional antibiotic, antifungal or antiviral treatment.