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Clinical Case Summary: Sweet’s Syndrome Triggered by Inhaled Therapy

Patient Profile:

• Age/Sex: 55-year-old female

• History: Hypertension, COPD

• Lifestyle: Smoker (10 cigarettes/day), no allergies

• Medications:

  • Enalapril (6 years)

  • Inhaled formoterol (2 years, recently discontinued)

  • New prescription: Inhaled indacaterol + glycopyrronium

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Clinical Presentation:

• Timeline: Symptoms began Day 2 after starting the new inhaled therapy

• Symptoms:

  • Painful, erythematous plaques on cheeks and neck

  • Low-grade fever

• Notable negatives:

  • No new cosmetics or foods

  • No recent infections

  • Recent sun exposure (with protection)

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Clinical Management & Diagnosis:

• Referral: Urgent referral to Dermatology

• Investigations:

  • Skin biopsy

  • Blood tests: CBC, autoantibodies, lupus anticoagulant, serology

• Initial Treatment: Oral corticosteroids

Findings:

• Leukocytosis with neutrophilia

• Negative serology and autoantibodies

• Biopsy confirmed Sweet’s syndrome

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Diagnosis: Sweet’s Syndrome

Also called acute febrile neutrophilic dermatosis

• Typical features:

  • Sudden onset of painful, red papules or plaques (face, neck, hands, trunk)

  • Systemic signs: fever, leukocytosis

  • Excellent response to corticosteroids

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Diagnostic Criteria (Two Major + Two Minor Required):

Major	Minor
1. Sudden painful erythematous or violaceous plaques/nodules	1. Fever or infection prodrome
2. Neutrophilic dermal infiltrate without vasculitis	2. Leukocytosis
	3. Associated arthralgia, conjunctivitis, fever, or malignancy
	4. Rapid response to corticosteroids
	5. Elevated ESR

Etiology and Triggers:

• Often idiopathic or drug-induced

• Triggers include:

  • Medications: contraceptives, antiepileptics, antibiotics, antihypertensives, colony-stimulating factors, vaccines

  • Infections, autoimmune diseases, malignancies (especially hematologic)

• More common in women when drug-induced

✅ Novel finding: This is the first reported case of Sweet’s syndrome linked to inhaled indacaterol/glycopyrronium, highlighting the need to consider non-traditional medications as potential triggers.

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Clinical Importance for Primary Care:

• Always consider Sweet’s syndrome in patients with acute onset of painful skin lesions + systemic symptoms

• Be aware of non-classic drug triggers, especially with new medications

• Initiate early referral and work-up to exclude associated malignancy, infection, or autoimmune disease

• Prompt steroid treatment leads to rapid symptom relief

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Final Notes:

• Ethical guidelines followed (patient consent obtained)

• No experiments on humans or animals

• All data managed in accordance with institutional privacy policies