Which symptom is NOT typically associated with the Jarisch-Herxheimer reaction?

• A. Fever
• B. Chills
• C. Rash
• D. Tachycardia

Answer: (C)

The Jarisch-Herxheimer reaction is an acute inflammatory response caused by rapid lysis of spirochetes after starting antibiotics. When the bacteria break apart, they release lipoproteins that trigger a surge of cytokines, leading to fever, chills or rigors, tachycardia, headache, and myalgias, and sometimes hypotension. This reaction usually begins within a few hours of antibiotic therapy and resolves within a day. A rash is not a typical part of this reaction; rashes are more often related to the underlying infection itself or a separate drug reaction, not the inflammatory response from spirochete destruction.