狒狒综合征1例

汪会峰; 杨爽; 王静; 李娜; 胡海友; 迟晓君; 崔灿; 张玉杰

doi:10.3969/j.issn.1674-8468.2025.02.009

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皮肤性病诊疗学杂志 ›› 2025, Vol. 32 ›› Issue (2) : 128-131. DOI: 10.3969/j.issn.1674-8468.2025.02.009

病例研究

狒狒综合征1例

作者信息 +

A case of baboon syndrome

Author information +

文章历史 +

摘要

报告1例狒狒综合征。患者女,58岁,因左侧胸腹部、双侧肘窝、腋窝等红斑伴瘙痒4 d就诊。患者5 d前曾接触破碎体温计,既往有含汞成分“红药水”接触过敏史。皮肤科检查: 左侧乳房及左腹部可见大片状鲜红色斑,边界清楚;双侧肘窝、腋窝及腹股沟可见对称分布暗红色斑,边界尚清,压之褪色,触之皮温稍高,未见糜烂、渗出。实验室及辅助检查:血常规,肝、肾功能、血糖及电解质均正常。乙型肝炎表面抗原(HBsAg)(-)、乙型肝炎表面抗体(HBsAb)(+)。心电图检查正常。诊断: 狒狒综合征。予口服依巴斯汀片10 mg,每早1次;盐酸西替利嗪片10 mg,每晚1次;外用炉甘石洗剂(每日4~5次),均用药7 d后停药。治疗第4天时皮损逐渐消退,伴脱屑,8 d后皮损完全消退,部分遗留色素沉着,10 d后色素沉着消退,皮肤恢复正常。目前仍随访中。

Abstract

A case of baboon syndrome is reported. A 58-year-old woman presented with a 4-day history of pruritic erythematous rashes on the left chest and abdomen, bilateral antecubital fossae, and axillae. The patient contacted a broken thermometer 5 days ago. She also had a history of contact allergy to a mercury-containing topical agent known as ″red medicine″.Dermatological examination revealed a large demarcated fresh patch on the left breast and abdomen. Symmetrically distributed dark red patches with clear boundaries were noticed in the bilateral antecubital fossae, axillae, and groins. The patches were blanched on pressure, and slightly warm could be felt. No erosions or exudation were observed. Laboratory examinations showed normal routine blood tests, liver and kidney function tests, blood glucose, and electrolyte levels. Hepatitis B surface antigen (HBsAg) was negative, while hepatitis B surface antibody (HBsAb) was positive. Electrocardiogram (ECG) was normal. Diagnosis:Baboon syndrome.The patient was treated with oral ebastine tablets (10 mg once daily in the morning), oral cetirizine hydrochloride tablets (10 mg once daily in the evening), and topical calamine lotion (4-5 times daily) for 7 days. The skin lesions gradually subsided on the 4th day of the treatment, accompanied by desquamation, and the lesions completely resolved, with some residual hyperpigmentation by the 8th day. By the 10th day, the skin appeared normal. The patient is still under follow-up.

导出引用

汪会峰, 杨爽, 王静, 等. 狒狒综合征1例[J]. 皮肤性病诊疗学杂志, 2025, 32(2): 128-131 https://doi.org/10.3969/j.issn.1674-8468.2025.02.009

WANG Huifeng, YANG Shuang, WANG Jing, et al. A case of baboon syndrome[J]. Diagnosis and Therapy Journal of Dermato-Venereology, 2025, 32(2): 128-131 https://doi.org/10.3969/j.issn.1674-8468.2025.02.009

1 临床资料

患者女,58岁。因左侧胸腹部、双侧肘窝、腋窝及腹股沟红斑伴瘙痒4 d就诊。5 d前患者接触破碎体温计,当时液态汞流出,经简单清扫后仍居住于污染房间,24 h后左侧乳房及左腹部出现红斑,瘙痒明显,夜间尤甚,影响睡眠,伴发热,体温最高37.3℃,伴寒战,于外院就诊,考虑过敏性皮炎,予静脉输注“克林霉素、阿米卡星、地塞米松”,口服“西替利嗪、枸地氯雷他定”联合外用“糠酸莫米松乳膏”等治疗后,体温降至正常,寒战消失,瘙痒程度较前稍有减轻,皮损较前变化不明显,但至第3天皮损迅速蔓延至双侧肘窝、腋窝及腹股沟等褶皱部位,瘙痒加剧,为明确诊断遂来我院就诊。患者自发病以来,精神及饮食可,睡眠欠佳,二便正常,体力及体质量无明显改变。患者既往体健,曾于20余年前为停止哺乳,双侧乳头部位外涂“红药水”后出现红斑,伴剧烈瘙痒,清洗掉后逐渐恢复正常;否认肝炎及结核等传染病史,无外伤及输血史。家族中无类似疾病患者。

体格检查:系统检查无异常。皮肤科检查:左侧乳房及左腹部可见大片状鲜红色斑,边界清楚;双侧肘窝、腋窝及腹股沟可见对称分布暗红色斑,边界尚清,压之褪色,触之皮温稍高,未见糜烂、渗出(图1A~1C)。

图1 患者临床图片可见大片状红色斑,边界清楚 1A:左侧乳房及左腹部;1B:右侧腋窝;1C:左侧肘窝

Figure 1 Clinical pictures of the patient: large,well-defined red patches. 1A:Left breast and left abdomen;1B:Right axilla;1C:Left antecubital fossa.

Full size|PPT slide

实验室及辅助检查:血常规,肝、肾功能、血糖及电解质均正常。乙型肝炎表面抗原(HBsAg)(-)、乙型肝炎表面抗体(HBsAb)(+)。心电图检查正常。

诊断:狒狒综合征。

治疗:予口服依巴斯汀片10 mg,每早1次;盐酸西替利嗪片10 mg,每晚1次;外用炉甘石洗剂(每日4~5次),用药7 d后均停药。电话随访,治疗第4天时皮损逐渐消退,伴脱屑,8 d后皮损完全消退,部分遗留色素沉着,10 d后色素沉着消退,皮肤恢复正常。嘱患者避免再次接触含有汞成分的体温计、血压计及红药水等。皮损未再复发,目前仍随访中。

2 讨论

狒狒综合征(baboon syndrome,BS)是系统性接触性皮炎(systemic contact dermatitis,SCD)的一种类型,本病可在数小时至2 d内发生,皮疹一般在3~5 d达高峰,随后在2~3周内脱屑消退,属于Ⅳ型变态反应^[1]。BS常有明确的接触史,一般为含汞物质,包括金属汞、有机汞和无机汞。对于已被汞致敏者,通过吸入破碎体温计产生的蒸发汞,可发生BS^[2]。引起BS的其他诱发因素有镍、抗生素、镇静催眠药、解热镇痛药、抗高血压药、抗肿瘤药、中药、造影剂等^[3⇓⇓-6]。至今国内外文献报道100余例BS,以儿童居多,国内较少见,国内报道的17例BS中有13例为接触破碎体温计^{[7⇓⇓⇓⇓⇓⇓⇓⇓-16]}、2例为中药成分^[17-18]、1例为苯妥英钠^[9]、1例为对乙酰氨基酚^[19]所致。本例患者为接触破碎体温计所致。

BS早期称为汞疹或汞皮炎,Nakayama等^[20]在1983年首次报道了15例接触破碎体温计或在牙科就诊后,身体褶皱部位出现对称性红斑,其中大多数患者有红汞过敏的接触性皮炎史。Andersen等^[21]在1984年报道由汞、镍、青霉素等引起腋窝、腹股沟、腘窝、会阴等皮肤褶皱间擦部位和屈侧出现水肿性红斑,颜色呈鲜红色,边界清楚,外观类似于狒狒的红臀,命名为BS。近年来,BS 的亚分类被创建,包括接触非药物变应原诱导 BS、局部药物诱导 BS 和全身药物诱导 BS,所有这些类型之前都存在皮肤致敏^[22]。随文献报道SCD 病例数量增加,发现局部药物诱导与全身药物诱导 BS 之间有区别。Hausermann等^[23]在2004年对50例BS研究发现,8例有明确的致敏史,被认为是真正的SCD,其余42例与口服或静脉用药有关,为了描述与未经致敏的全身性药物相关的病例,因此提出将与口服或静脉用药相关的(对药物的外部接触过敏史除外)以BS为临床表现的药疹称为对称性药物相关性间擦部及屈侧疹(symmetric drug-related intertriginous and flexural exanthema,SDRIFE)。BS与SDRIFE表现相似,主要区别在于BS有接触致敏史。目前SDRIFE仍作为BS的一种,未能从发病机制上明确区分,概念上仍有混淆^[24]。

早期诊断BS对治疗策略和改善预后至关重要。在临床实践中,诊断BS的最佳方法主要依靠医生快速评估可疑病例并得出决定性的诊断。BS在诊断时需要注意与其他常见于屈侧区皱褶部位的皮肤病相鉴别,如真菌感染、颗粒状角化不全病、家族性良性慢性天疱疮、反转型银屑病、Darier病、间擦疹等。本例患者既往有含汞成分“红药水”接触过敏史,且现有破碎体温计接触史,皮疹表现为鲜红色或暗红色斑,边界清楚,分布以屈侧区褶皱部位多见,皮疹较为典型,结合患者既往史、现病史及皮疹临床特点,符合SCD,因此诊断为BS。BS皮损常见于屈侧区皱褶部位,推测可能跟褶皱部位皮肤角质层较薄、汗液分泌旺盛、致敏原容易滞留等有关,有待于进一步研究。

本病需去除病因,对症治疗。本例患者首先脱离致敏环境,避免再次接触蒸发“汞”等诱发因素,然后经口服及外用抗过敏止痒药物治疗后皮损完全消退,皮肤恢复正常,提示BS预后良好。

参考文献

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