Recurrent Flexural Exanthema (SDRIFE or Baboon Syndrome) after Administration of Two Different Iodinated Radio Contrast Media

Abstract

In 1984, the baboon syndrome was described as a particular form of systemic contact dermatitis that occurred after the administration of a contact allergen in individuals previously sensitized by topical exposure to the same allergen. Its clinical picture presents as an erythema of the buttocks and upper inner thighs resembling the red bottom of baboons. This specific reaction was originally observed with mercury, nickel and ampicillin. Since then over 100 cases have been described, most of them without known prior sensitization to the causative agent. In 2004, our group proposed the acronym SDRIFE specifically for cases associated with systemic drugs; it stands for symmetrical drug-related intertriginous and flexural exanthema, as a distinct reaction pattern related to systemic drugs. Here we describe a case of SDRIFE after administration of the iodinated radio contrast medium (RCM) iomeprol (Iomeron®), accidentally reproduced by the RCM iopromide (Ultravist®). Positive delayed skin tests with both drugs were observed indicating that the pathomechanism of SDRIFE is likely a cell-mediated type IV allergy. Oral potassium iodide and a skin-test-negative RCM were administered and both tolerated, indicating that the antigen is related to the molecules and not to iodine itself. Therefore, in our case skin tests had a good positive and negative predictive value.

SDRIFE – Another Acronym for a Distinct Cutaneous Drug Exanthema: Do We Really Need It?

“…the symmetrical intertriginous and flexural involvement of the exanthema. SDRIFE, unlike BS, is a neutral term that avoids ethically and culturally offensive comparisons with an animal and, most importantly, identifies a relatively benign particular type of drug eruption, facilitating the diagnosis, prognosis and management of individual patients [10] . We believe this acronym is a useful addition to the existing terms.…”

Symmetrical Drug-Related Intertriginous and Flexural Exanthema Caused by Valacyclovir

“…Amoxicillin is the most common drug causing SDRIFE, followed by cephalosporins, mitomycin C and radio contrast media [4]. We report herein a first case of acyclovir- and valacyclovir-induced SDRIFE, which was confirmed by an oral provocation test.…”

Symmetrical Drug-Related Intertriginous and Flexural Exanthema – Reply

“…We congratulate Arnold et al [1] for their interesting report on symmetrical drug-related intertriginous and flexural exanthema (SDRIFE, baboon syndrome). We especially commend the first criterion of this syndrome stating, what we emphasized some 15 years ago [2] , that SDRIFE should be distinguished from hematogenous or systemic contact-type dermatitis, as suggested by Andersen et al [3] , when they first reported this syndrome.…”

“…Second, the fifth criterion of SDRIFE is absence of systemic symptoms and signs, which according to the authors [1] is important to distinguish SDRIFE from drug rash with eosinophilia and systemic symptoms (DRESS). Here, we disagree.…”