{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,4,27]],"date-time":"2025-04-27T16:40:07Z","timestamp":1745772007575,"version":"3.40.4"},"reference-count":7,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"abstract":"<jats:p>A 49-year-old man with a history of hypertension and no known drug allergies was admitted with a 4-day history of fever, general malaise, sore throat and diarrhoea. Eleven days ago, he had returned from a 2-week adventure holiday to South Africa. On admission, he was noted to have a creatinine 392\u2005\u00b5mol\/L, alanine aminotransferase 133\u2005IU\/L, alkaline phosphatase 211\u2005IU\/L and platelets 151\u00d710<jats:sup>9<\/jats:sup>\/L. A differential diagnosis of suspected leptospirosis or bacterial sepsis was made and he was started on ceftriaxone. Two hours later he became hypotensive, tachypnoeic with severe myalgia and a temperature of 41\u00b0C, type I respiratory failure and metabolic acidosis. There was no stridor, facial swelling or rash. A diagnosis of Jarisch-Herxheimer reaction was made. A second dose of ceftriaxone was given without any reaction. The patient thereafter completed 7\u2005days of doxycycline. PCR confirmed leptospirosis and subsequent leptospirosis IgM was positive. He improved clinically with treatment and was discharged after 10\u2005days of admission.<\/jats:p>","DOI":"10.1136\/bcr-2013-201075","type":"journal-article","created":{"date-parts":[[2013,10,9]],"date-time":"2013-10-09T15:40:31Z","timestamp":1381333231000},"page":"bcr2013201075","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Risky behaviour: a rare complication of an uncommon disease in a returning traveller"],"prefix":"10.1136","volume":"2013","author":[{"given":"Dominic","family":"Pimenta","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jane","family":"Democratis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2013,10,9]]},"reference":[{"key":"2025042709271264000_2013.oct09_1.bcr2013201075.1","unstructured":"Public Health England Leptospirosis: Epidemiology. http:\/\/www.hpa.org.uk\/webw\/HPAweb&HPAwebStandard\/HPAweb_C\/1287144899527 (accessed 29 Apr 2013)."},{"key":"2025042709271264000_2013.oct09_1.bcr2013201075.2","doi-asserted-by":"crossref","first-page":"e59266","DOI":"10.1371\/journal.pone.0059266","article-title":"The Jarisch-Herxheimer reaction in leptospirosis: a systematic review","volume":"2013","author":"Guerrier","year":"2013","journal-title":"PLoS One"},{"key":"2025042709271264000_2013.oct09_1.bcr2013201075.3","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1001\/jama.1986.03380030090035","article-title":"Evaluation for endotoxemia in patients receiving penicillin therapy for secondary syphilis","volume":"2013","author":"Shenep","year":"1986","journal-title":"JAMA"},{"key":"2025042709271264000_2013.oct09_1.bcr2013201075.4","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1016\/S0736-4679(98)00011-0","article-title":"Lyme disease complicated by the Jarisch-Herxheimer reaction","volume":"2013","author":"Maloy","year":"1998","journal-title":"J Emerg Med"},{"key":"2025042709271264000_2013.oct09_1.bcr2013201075.5","first-page":"15","article-title":"The effect of prednisolone on the Jarisch-Herxheimer reaction","volume":"2013","author":"Gudj\u00f3nsson","year":"1968","journal-title":"Acta Derm Venereol"},{"key":"2025042709271264000_2013.oct09_1.bcr2013201075.6","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1056\/NEJM199608013350503","article-title":"Prevention of Jarisch-Herxheimer reactions by treatment with antibodies against tumor necrosis factor alpha","volume":"2013","author":"Fekade","year":"1996","journal-title":"N Engl J Med"},{"key":"2025042709271264000_2013.oct09_1.bcr2013201075.7","unstructured":"Public Health England. Hantavirus background information. http:\/\/www.hpa.org.uk\/web\/HPAweb&Page&HPAwebAutoListDate\/Page\/1191942172917 (accessed 29 Apr 2013)."}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2013-201075","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,27]],"date-time":"2025-04-27T16:27:18Z","timestamp":1745771238000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2013-201075"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,10,9]]},"references-count":7,"alternative-id":["10.1136\/bcr-2013-201075"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2013-201075","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2013,10,9]]}}}