Manifestations include fever, chills, headache, myalgias, and exacerbation of cutaneous lesions.
[medical-dictionary.thefreedictionary.com]
The Herxheimer reaction has shown an increase in inflammatory cytokines during the period of exacerbation, including tumor necrosis factor alpha, interleukin-6 and interleukin
[en.wikipedia.org]
[…] hours after the first dose of antibiotics as fever, chills, rigor, hypotension, headache, tachycardia, hyperventilation, vasodilation with flushing, myalgia (muscle pain), exacerbation
[en.wikipedia.org]