Recognizing Sweet Syndrome: When a Skin Reaction Signals Something More

A 55-year-old woman with a history of high blood pressure and COPD arrived at her doctor’s office with an alarming skin reaction. Just two days after switching to a new inhaler medication (indacaterol/glycopyrronium combination), she developed painful red patches on her cheeks and neck accompanied by a mild fever. What seemed like a simple allergic reaction turned out to be something much more serious – Sweet syndrome.

This rare skin condition, medically known as acute febrile neutrophilic dermatosis, typically appears as sudden, painful red or purple bumps or plaques, often on the face, neck, or upper body. The patient’s symptoms matched the classic presentation: skin lesions, fever, and blood tests showing increased white blood cells (particularly neutrophils). A skin biopsy confirmed the diagnosis after other possibilities like lupus or contact dermatitis were ruled out.

What makes Sweet syndrome particularly important to recognize is its potential connection to underlying health issues. While sometimes triggered by medications (as in this case), it can also signal infections, autoimmune disorders, or even certain cancers. The condition responds remarkably well to corticosteroid treatment – this patient’s symptoms improved within days of starting medication.

This case stands out because it’s the first reported instance of Sweet syndrome linked to this particular inhaler combination. It serves as an important reminder that even uncommon reactions should be considered when new symptoms appear after medication changes. For healthcare providers, recognizing these distinctive signs can lead to faster diagnosis and prevent unnecessary testing for more common conditions.

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