Doxycycline
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Jarisch Herxheimer reaction: case report A 13-year-old boy developed Jarisch-Herxheimer reaction during treatment with doxycycline for Lyme arthritis [not all routes stated]. The boy was admitted to hospital with left knee swelling, ankle, hip and cervical spine pain. His anamnesis revealed a knee arthritis, which appeared 6 months prior to admission and had received unspecified NSAIDs in an outpatient department, which showed slight positive effect. His history also revealed falling down and post-traumatic arthritis was suspected. He was referred to a rheumatologist, who determined an additional history of a tick bite 9 months prior to the onset of arthritis. He received doxycycline 100mg twice daily for four days following the tick bite to prevent the development of Lyme borreliosis. Considering the history of a tick bite, he underwent serological testing for Lyme borreliosis. Enzyme immunoassays and Western blot analysis for anti-Borrelia burgdorferi IgG and IgM were positive confirming Lyme arthritis. Oral doxycycline 100mg twice daily was initiated for another 3 weeks. However, his condition deteriorated with a low grade fever, myalgias and severe arthralgias with intense ankle, hip and cervical spine pain on day 7 of oral doxycycline therapy. Laboratory tests revealed haemoglobin 10.1 g/dL, leucocytes 1212 cells/µL and platelet count 429 000 cells/µL. The clinical findings were consistent with Jarisch-Herxheimer reaction attributed to doxycycline. The boy continued receiving doxycycline. He received treatment with prednisolone and unspecified NSAIDs to relieve pain. His symptoms slightly reduced, but did not resolve completely by the end of doxycycline therapy. Therefore, he was referred to another regional hospital. Physical examination showed painful and swollen left knee, the skin over the joint was ’hot’. His CRP and ESR were elevated. He was initiated on treatment with ceftriaxone. During the ceftriaxone treatment, his condition improved, arthralgias reduced and signs of arthritis resolved. Nykytyuk S, et al. The Jarisch-Herxheimer reaction associated with doxycycline in a patient with Lyme arthritis. Reumatologia 58: 335-338, No. 5, 2020. Available from: 803519799 URL: http://doi.org/10.5114/reum.2020.99143
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Reactions 12 Dec 2020 No. 1834
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