A 55-year-old woman visited her clinic after noticing painful, red patches on her face and neck. At first, there was no reason to suspect anything serious — but her symptoms soon revealed a rare inflammatory condition known as Sweet’s syndrome. What made this case unique was the suspected trigger: a newly prescribed inhaled bronchodilator capsule, something not commonly associated with this condition.
Initial Symptoms
The patient had a history of hypertension and chronic obstructive pulmonary disease (COPD). She had used inhaled medications for years without complications. After her COPD worsened, her treatment was changed to a combination inhaler containing indacaterol and glycopyrronium.
Within two days, she developed:
- Painful red plaques on her face and neck
- Mild fever
- Fatigue
She had not changed skincare products, had minimal sun exposure, and reported no recent infections.
Clinical Evaluation
Due to the rapid development of symptoms, she was referred to Dermatology. Her care team recommended:
- Stopping the new inhaler
- Starting a short course of corticosteroids
- Blood tests
- A skin biopsy
Her symptoms began improving within 48 hours of stopping the medication.
Diagnostic Results
- Bloodwork: Elevated white blood cell count with neutrophilia
- Autoimmune tests: Negative
- Skin biopsy: Neutrophilic inflammation without signs of vasculitis
These findings supported the diagnosis of Sweet’s syndrome, also called acute febrile neutrophilic dermatosis.
While Sweet’s syndrome can be triggered by infections, autoimmune disorders, or medications, it is rarely associated with inhaled drugs. This made the case medically noteworthy.
Understanding Sweet’s Syndrome
Sweet’s syndrome typically presents with:
- Sudden, painful skin lesions
- Systemic symptoms such as fever
- Elevated white blood cell counts
- Specific biopsy findings
Common medication triggers are usually systemic (oral or injectable), making this inhaled-therapy association unusual.
Other Possible Diagnoses Considered
Doctors also evaluated for:
- Allergic skin reactions
- Lupus
- Photodermatitis
- Drug-induced skin inflammation
- Rosacea flare
These were ruled out based on symptoms and biopsy findings.
Treatment and Recovery
The patient responded quickly to:
- Stopping the suspected inhaled medication
- A short corticosteroid treatment
Her skin lesions resolved within a week, and she remained symptom-free at follow-up appointments.
Clinical Takeaways
This case highlights several important points for healthcare providers:
- New medication reactions should be considered when skin symptoms appear suddenly.
- Even inhaled therapies may cause unexpected immune responses in rare cases.
- Early dermatological evaluation and biopsy can help ensure accurate diagnosis.
- Sweet’s syndrome may indicate other underlying health conditions, so full clinical assessment is recommended.
Ethical Considerations
- No experimental procedures were performed.
- Patient identity was protected.
- Written consent was obtained for sharing the case details.
Conclusion
This case demonstrates a rare presentation of Sweet’s syndrome potentially linked to an inhaled bronchodilator capsule. It serves as a reminder that unusual symptoms after a medication change should be evaluated promptly, and that sometimes the body’s first warning sign comes through the skin rather than the lungs.