Symmetrical drug-related intertriginous and flexural exanthema (baboon syndrome) caused by cotrimoxazole

Introduction
Symmetrical drug-related intertriginous and flexural exanthema (SDRIFE or baboon syndrome) is an uncommon form of systemic contact dermatitis, readily differentiated from other drug eruptions by its peculiar appearance.

Case report
A 48-year-old male presented with itchy erythematous rash with blisters two days after taking an unknown drug. Dermatological examination revealed symmetrical erythematous macules with large bullae over the anterior trunk, neck, inner thighs and axillae. Systemic examination and laboratory parameters were normal. A diagnosis of symmetrical drug-related intertriginous and flexural exanthema associated with cotrimoxazole was made based on dermatological findings, histopathology and the reappearance of lesions after administration of cotrimoxazole (trimethoprim 160 mg and sulfamethoxazole 800 mg twice daily). Coincidentally, he was detected to be HIV seropositive and started a highly active antiretroviral therapy. His skin lesions resolved with systemic glucocorticosteroids.

Conclusions
Patients and clinicians should be aware of the possibility of a baboon syndrome due to cotrimoxazole, a widely used drug.