Article in Japanese

A case of congenital syphilis with hyperferritinemia and hyperlactic acidemia in the Jarisch-Herxheimer reaction

Junichi ISHIKAWA^1）, Keita KURAKAZU^1）, Takahiro HORITA^1）, Hideo OKUNO^1）, Tomomi YOSHINO^1）, Kiyoko AMO^1）, Masashi SHIOMI^2）

Jarisch-Herxheimer Reaction (JHR) resolves within a day or two. We report a case of congenital syphilis with hyperferritinemia and hyperlactic acidemia associated with JHR.
The patient was a neonatal boy who was admitted to the hospital with a chief complaint of fever and moaning. After admission, he was started on antimicrobial therapy for suspected sepsis. However, his hypoglycemia and lactic acidosis worsened the following day. Thus, he was transferred to our hospital at 24 days of age. Upon arrival, he was tachycardic and febrile. Blood test results indicated an inflammatory response, elevated hepatic enzymes, hyperferritinemia, and hyperlactic acidemia. Consequently, the patient was admitted to the pediatric intensive care unit (PICU) and started on steroid pulse therapy. He was diagnosed with congenital syphilis and continued to receive treatment with penicillin G. The next day, the patient’s fever resolved, and his respiratory status gradually stabilized. The patient was discharged after 10 days of continued antimicrobial therapy.
JHR can be complicated by signs of shock, necessitating cautious management.

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1）Osaka City General Hospital
2）Aizenbashi Hospital

Key words	congenital syphilis, steroid pulse therapy, hyperferritinemia, hyperlactic acidemia, Jarisch-Herxheimer Reaction
Received	December 15, 2023
Accepted	March 11, 2024

36 (2)：153─159,2024