While the visible symptoms subsided quickly, the biopsy results revealed an unexpected diagnosis—Sweet syndrome, a rare immune-driven skin disorder.
This unusual case may mark the first time an inhaled medication has been linked to this condition, raising new questions about hidden risks in commonly prescribed treatments.
Case Overview
The patient, with a medical history including hypertension and COPD, had been stable on enalapril and formoterol inhaler for years. Due to declining lung function, her pulmonologist switched her inhaler to a combination of indacaterol and glycopyrronium. Just 48 hours after starting the new inhaler, she presented with painful erythematous plaques on her face and neck, plus a low-grade fever. She denied new cosmetic use, diet changes, or cold symptoms but mentioned recent sun exposure with proper protection.
Referred urgently to dermatology, she discontinued the inhaler. Blood tests ruled out infections and autoimmune markers, while a skin biopsy confirmed Sweet syndrome. Oral corticosteroids were prescribed, leading to rapid symptom improvement within two days.
Understanding Sweet Syndrome
Also known as acute febrile neutrophilic dermatosis, Sweet syndrome is characterized by sudden onset of painful, red papules or plaques—often asymmetrical—primarily affecting the face, neck, upper torso, and hands. It typically presents with systemic symptoms such as fever and elevated white blood cells.
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