The response to treatment was swift. Within 48 hours, her fever subsided, pain decreased, and the skin lesions began to fade—strongly supporting a medication-related cause.
A skin biopsy confirmed the diagnosis: Sweet syndrome, also known as acute febrile neutrophilic dermatosis. This rare inflammatory condition is marked by the sudden appearance of painful red or purple plaques, fever, and elevated white blood cell counts. It occurs when neutrophils—key immune cells—abnormally accumulate in the skin.
Sweet syndrome can be triggered by infections, autoimmune conditions, pregnancy, cancers, and certain medications. While drug-induced cases are well documented, this case stood out because inhaled bronchodilators like indacaterol and glycopyrronium had not previously been linked to the condition, making it clinically significant.
Doctors carefully ruled out other possible diagnoses, including allergic reactions, lupus-related skin disease, and other inflammatory disorders. The absence of systemic involvement, combined with biopsy findings and rapid improvement after stopping the medication, confirmed the diagnosis.
The patient continued to recover fully, with no recurrence of symptoms. Her COPD treatment was later adjusted using alternative therapies, with close monitoring to prevent future reactions.
This case serves as a powerful reminder for both clinicians and patients: even medications with strong safety records can, in rare instances, cause unexpected reactions. Paying close attention to new symptoms—especially those that appear shortly after a medication change—can lead to faster diagnosis and better outcomes.
Early recognition, prompt drug discontinuation, and appropriate treatment made all the difference in this case, preventing prolonged discomfort and unnecessary testing.
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