Clinical Case Summary: Sweet’s Syndrome Triggered by Inhaled Therapy
Patient Profile:
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Age/Sex: 55-year-old female
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History: Hypertension, COPD
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Lifestyle: Smoker (10 cigarettes/day), no allergies
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Medications:
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Enalapril (6 years)
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Inhaled formoterol (2 years, recently discontinued)
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New prescription: Inhaled indacaterol + glycopyrronium
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Clinical Presentation:
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Timeline: Symptoms began Day 2 after starting the new inhaled therapy
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Symptoms:
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Painful, erythematous plaques on cheeks and neck
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Low-grade fever
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Notable negatives:
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No new cosmetics or foods
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No recent infections
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Recent sun exposure (with protection)
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Clinical Management & Diagnosis:
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Referral: Urgent referral to Dermatology
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Investigations:
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Skin biopsy
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Blood tests: CBC, autoantibodies, lupus anticoagulant, serology
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Initial Treatment: Oral corticosteroids
Findings:
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Leukocytosis with neutrophilia
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Negative serology and autoantibodies
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Biopsy confirmed Sweet’s syndrome
Diagnosis: Sweet’s Syndrome
Also called acute febrile neutrophilic dermatosis
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Typical features:
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Sudden onset of painful, red papules or plaques (face, neck, hands, trunk)
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Systemic signs: fever, leukocytosis
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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:
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Often idiopathic or drug-induced
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Triggers include:
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Medications: contraceptives, antiepileptics, antibiotics, antihypertensives, colony-stimulating factors, vaccines
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Infections, autoimmune diseases, malignancies (especially hematologic)
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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.
Clinical Importance for Primary Care:
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Always consider Sweet’s syndrome in patients with acute onset of painful skin lesions + systemic symptoms
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Be aware of non-classic drug triggers, especially with new medications
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Initiate early referral and work-up to exclude associated malignancy, infection, or autoimmune disease
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Prompt steroid treatment leads to rapid symptom relief
Final Notes:
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Ethical guidelines followed (patient consent obtained)
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No experiments on humans or animals
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All data managed in accordance with institutional privacy policies