Abstract

Symmetric drug related intertriginous and flexural exanthema (SDRIFE), commonly known as Baboon Syndrome, is a rare condition in which an erythematous rash erupts in the body’s major flexural folds, including axillary, inguinal, and gluteal, in a distinctive symmetrical pattern due to a type IV delayed hypersensitivity reaction to a systemic drug with absence of systemic symptoms. Early clinical and histopathologic presentations of SDRIFE are non-specific and erythema multiforme (EM) can be in the clinical and histopathological differential diagnosis. To our knowledge, exceedingly rare EM-like SDRIFE cases have been previously reported. We present an EM-like SDRIFE case of a 72-year-old female who developed an erythematous, painful, and pruritic rash over her extremities, face, and back and endorsed painful oral lesions one day after taking oral amoxicillin for a dental infection. On examination, multiple large erythematous patches in the axilla, under the breasts, and groin comprising roughly 20% total body surface area were noted; however, she displayed no systemic symptoms, no skin peeling or sloughing and no targetoid lesions. A biopsy from affected skin in the thigh fold showed interface dermatitis with scattered apoptotic keratinocytes at all levels of the epidermis and with underlying perivascular and interstitial mixed inflammation with neutrophils and eosinophils, resembling histologic findings seen in EM. Clinicopathological correlation is necessary to differentiate EM-like SDRIFE from EM, as EM-like SDRIFE is a benign condition that resolves with discontinuation of the offending drug and EM can have permanent ocular sequelae if not identified early.

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