Baboon syndrome is a benign self-limiting type IV drug sensitivity reaction that was first described in 1984 by Anderson et al (1) . It presents with a very characteristic rash in the gluteal and intertriginous areas with symmetry of lesions hours to two days after exposure to the offending agent. Mucosal involvement is not present and involvement of the face and palmoplantar surfaces is rare. Atypical features that have been reported include pustules, papules or bullae overlying a flexural exanthema as seen in our patient (3-7).
It is unknown why the rash presents in flexural surfaces. Two theories have been proposed. One suggests it’s a form of recall phenomenon from a previous unrelated dermatitis (8) or another theory suggests that metabolites of the causative agent are excreted preferentially from eccrine glands found in flexures (9). However this doesn’t account for the exanthema in the gluteal region, which is the main diagnostic criterion for baboon syndrome.
Antibiotics, particularly beta-lactams, account for the majority of cases of baboon syndrome. Other drugs implicated include antihypertensives, radiocontrast media, nickel, mercury, omeprazole, clozapine, roxithromycin, ceftriaxone, intravenous immunoglobulins, chemotherapeutic agents and biologics. To our knowledge, methamphetamines have not been documented as a cause of baboon syndrome. This case is particularly challenging because of the uncertainty of the methamphetamine makeup. According to Winnicki and Shear there have been two reported cases of baboon syndrome after exposure to pseudoephedrine (10). This could be the underlying etiology of the baboon syndrome in this case, although it is known that methamphetamine can be made with lighter fluid, drain cleaners, anhydrous ammonia, ethyl ether and acetone to name a few (11).
Diagnosis is generally made clinically however sometimes with the aide of a biopsy. Controller drug-provocation testing is the gold standard for diagnosis however rarely used.
The condition is self-limiting however topical and parenteral steroids have been shown to hasten recovery and provide symptomatic relief (12-13). Recovery may take up to 3 weeks.
The patient was prescribed a low dose 15 day taper of prednisone and triamcinolone 0.1% ointment which was applied topically to the affected areas twice daily for no longer than two weeks.
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11. Mosier, S MD. Meth Lab Components. Kansas Department of Health and Environment. http://www.kdheks.gov/methlabs/meth_lab_components.html. Oct. 26, 2015
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