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Jarisch-Herxheimer Reaction Triggered by Group B Streptococcus Intrapartum Antibiotic Prophylaxis

BACKGROUND: The Jarisch-Herxheimer reaction is an acute systemic event that can occur during the treatment of spirochetal infections. During pregnancy, it can cause signs and symptoms in both the mother and fetus, including fever, tachycardia, uterine contractions, and fetal heart rate pattern changes. CASE: A pregnant woman with limited prenatal care presented at 34 weeks of gestation in preterm labor with possible genital herpes. She received ampicillin for group B Streptococcus prophylaxis. Subsequently, she experienced subjective fever and late fetal heart rate decelerations prompting repeat cesarean delivery. Postpartum, her genital lesions were diagnosed as secondary syphilis, and her newborn had congenital syphilis. CONCLUSION: Beta-lactam antibiotics for group B Streptococcus intrapartum prophylaxis can trigger the Jarisch-Herxhemer reaction in patients with undiagnosed syphilis resulting in unanticipated changes in maternal and fetal well-being.