Fixes Arzneimittelexanthem auf Terbinafin mit charakteristischem Verteilungsmuster eines Baboon-Syndroms

Abstract

A 26 year old patient developed a fixed drug eruption located on his hands, inguinal and gluteal areas following oral treatment of onychomycosis with terbinafine. The rash showed the characteristic distribution of the "baboon-syndrome", so-named because of the red perianal region of the baboon. Although epicutaneous testing revealed no positive reaction, the rash could be induced in identical sites by oral administration of terbinafine. As the underlying pathomechanism for the "baboon-syndrome" a systemically induced allergic contact dermatitis has been suggested. In addition to the described substances, e.g. mercury, amoxicillin, ampicillin, heparin and nickel, this is the first report of "baboon syndrome" induced by terbinafine.

Current understanding of Baboon syndrome

“…One should be aware that, in most reactions, different type IV reactions may occur together, and cytotoxic functions by either CD4 + or CD8 + T cells (type IVc) seem to participate in all type IV reactions [57]. Overlapping features of FDE and AGEP in patients with BS [32,58,59] are thus not surprising. The accumulation of neutrophils in BS might be regarded as an overlapping feature of AGEP, in which a combination of type IVc and type IVd reactions lead to recruitment and activation of neutrophils by T cells via IL-8 (CXCL-8) and granulocyte-macrophage colonystimulating factor release [57].…”

“…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].…”

“…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].…”

“…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 …”

Pigmentierung des Gesichtes unter Therapie mit Terbinafin

“…ei nes Ste vens-John son-Syn droms [9] dar. Auch fixe Arz nei mit te lex an the me sind beschrie ben wor den [10].…”