First report of tamoxifen‐induced baboon syndrome

Abstract

Background Baboon syndrome is a rare, type IV hypersensitivity reaction causing a maculopapular rash. Tamoxifen is an antineoplastic agent, working as an estrogen receptor antagonist, also called a selective estrogen receptor modulator. A variety of rashes were reported with Tamoxifen use to‐date except baboon syndrome. The Tamoxifen‐induced baboon syndrome seems to be reversible, as discontinuation of the drug improves clinical outcomes. Aim Herein, we present the first case of Tamoxifen‐induced baboon syndrome which occurred 8 years after initiation of Tamoxifen use. Patients A 44‐year‐old woman presented with papulovesicular eruption on her body and erythema on her face for a duration of 6 months. There was no evidence of ocular or mucosal involvement. She was diagnosed with breast cancer and treated with tamoxifen 10 mg twice daily over the past 8 years. She was not taking other medications or over‐the‐counter supplements at the time of presentation. The patient underwent urgent skin biopsies of two lesions on her buttock and thigh. No organisms were seen on Gram stain. The patient's skin biopsy revealed extensive hyperorthokeratosis, minimal parakeratosis, hypergranulosis, and lichenoid interface dermatitis in the irregularly acanthotic epidermis supporting diagnosis of fixed drug eruption. Following a multidisciplinary discussion, the patient was diagnosed with baboon syndrome or symmetrical drug‐related intertriginous and flexural exanthema (SDRIFE) associated with Tamoxifen. Results Hence, Tamoxifen was immediately discontinued and treated with oral steroid along with topical agents. She showed improvement of clinical abnormalities within days after discontinuation of Tamoxifen. Conclusions Given the widespread use of Tamoxifen in the management of patients with breast cancer, it is important that healthcare professionals monitor for rare, however clinically significant, and potentially life‐threatening dermatological manifestations of Tamoxifen use, such as baboon syndrome.

Efficacy, Safety, and Prognosis of Sequential Therapy with Tamoxifen and Letrozole versus Letrozole Monotherapy for Breast Carcinoma

“…Both TAM and LTZ are common antiestrogen drugs in clinic [ 8 ]. Among them, TAM is an antitumor drug, which is used as an estrogen receptor regulator in adjuvant endocrine therapy for hormone-dependent BC [ 9 , 10 ]. LTZ, a common endocrine drug, is an aromatase inhibitor that blocks estrogen synthesis by inhibiting the final step of the estrogen biosynthesis pathway [ 11 ].…”

Symmetrical drug‐related intertriginous and flexural exanthema/baboon syndrome induced by traditional Chinese medicine

“…The offending agents of SDRIFE/baboon syndrome are drugs especially antibiotics, such as cephalosporins, penicillins etc.. 6,[8][9][10][11][12][13] Besides drugs, mercury and nickel are very common implicated agents, 5,14 and fragrance such as balsam of peru. 15 And a case of Baboon syndrome after streptococcal infection has been reported.…”

Baboon syndrome (SDRIFE) after Valsartan/Hydrochlorothiazide intake for several years

“… 3 Other non-antimicrobial agents including codeine, paracetamol, heparin, tamoxifen, antihistamines, iodine contrast media and chemotherapeutic agents including some monoclonal antibodies such as infliximab have also been indicted to cause this reactive condition. 3 , 4 Many of such cases have shown to occur after several days of primary exposure to the drug without any prior sensitization. 3 , 4 However, contrary to this fact, cases have also been documented where drug-induced baboon syndrome/SDRIFE has occurred several years after initiation of use.…”

“… 3 , 4 Many of such cases have shown to occur after several days of primary exposure to the drug without any prior sensitization. 3 , 4 However, contrary to this fact, cases have also been documented where drug-induced baboon syndrome/SDRIFE has occurred several years after initiation of use. 3 , 4 Mofarrah and colleagues, for example, documented the first report of Baboon syndrome that occurred 8 years after tamoxifen use.…”

“…Of all the drug-induced agents reported, amoxillicin, ceftriaxone, penicillin and erythromycin have been identified as the most common causative agents of SDRIFE [3]. Other nonantimicrobial agents including codeine, paracetamol, heparin, tamoxifen, antihistamines, iodine contrast media and chemotherapeutic agents including some monoclonal antibodies such as infliximab have also been indicted to cause this reactive condition [3,4]. Many of such cases have shown to occur after several days of primary exposure to the drug without any prior sensitization [3,4].…”