Symmetric Ptychotropic and Nonpigmenting Fixed Drug Eruption due to Cimetidine (So-Called Baboon Syndrome)

Baboon syndrome and toxic erythema of chemotherapy: Fold (intertriginous) dermatoses

“…Immunohistologic findings on skin biopsies have indicated an infiltration with predominantly CD4 + -positive T cells in the dermis. 18,19 Positive patch tests, delayed skin tests, 20 and lymphocyte transformation tests 7,21 further support a T-cell-mediated delayed-type hypersensitivity pathomechanism.…”

Current understanding of Baboon syndrome

“…Examples of systemic absorption following topical exposure Inhalation of mercury vapor mainly from broken thermometer [16] or nickel vapor from paints [65]; ingestion of food containing nickel [65] or nickel-chelating agents [1] or accidental ingestion of mercury-containing cream [62]; suppositories containing balsam of Peru [5] Contact with poison ivy [202] Contact allergenic druginduced BS Yes Yes Aminophylline [93,94], neomycin [95], nystatin [96], corticosteroids [77,97], erythromycin[18], amoxicillin [29], ampicillin[1], 5-aminosalycilic acid [72], bufexamac [73], cinchocaine [24,74] Oral [44,103], clindamycine [104], roxithromicin [105], allopurinol [38], contrast media [32,46], cimetidine [106], deflazacort [41], hydroxyurea [36], heparin [39], intravenous immunoglobulin [45], mitomycin C [71,107], naproxen [32], oxycodone [32], salsalate [25], terbinafine [58], cetuximab [35], valacyclovir [108] Oral (the majority); intravenous [32,35,39,45,46]; intravesical …”

“…Amoxicillin was the leading eliciting agent [17,19,21,22,26,27,29,31,32,43,59,[98][99][100], followed by ampicilllin [101], pivampicillin [102], penicillin V [33], ceftriaxone [32], cefuroxime [17,32] and cephalexin [32]. Several other drugs have also been involved, such as pseudoephedrine [44,103], clindamycin [104], roxithromycin [105], allopurinol [38], barium sulfate-containing contrast media [32], iodinated radiocontrast media [46], cimetidine [106], oral deflazacort [41], hydroxyurea [36], heparin [39], IVIg [45], mitomycin C (intravesical instill ation) [71,107], naproxen [32], oxycodone [32], salsalate [25], terbinafin [58], cetuximab [35] and valacyclovir [108]. A pediatric patient developed BS 1 day after ingestion of cefadroxil, paracetamol and a cough mixture, but further ana lysis of the causative agent could not be performed [109].…”

“…Moreover, delayed prick test reading was positive with amoxicillin [99], allopurinol [38] and heparin [39], delayed reading of an intradermal test with ampicillin and benzyl penicillin [22], iodinated radiocontrast media [46], penicillin V and G [33], mast cell degranulation test with clindamycine [104] and oral provocation test (OPT) with amoxicillin [17], clindamycine [104], cimetidine [106], IVIg [45], terbinafin [58], iodinated contrast media [46], valacyclovir [108] and crossreactive phenoxymethylpenicillin in a patient with amoxicillin-induced BS [59].…”

“…Oral provocation tests with inducer drugs [17,58,104,106] or crossreactive compounds [59] have been positive in BS patients with negative skin test results. It is generally considered safe to perform a drug challenge in delayed-type immune reactions according to current guidelines [5,9,118].…”