This case involves a 55-year-old woman with hypertension and COPD, treated with enalapril and formoterol. Following a change in inhalation therapy to indacaterol/glycopyrronium, she presented with painful, erythematous facial and neck lesions and low-grade fever. She denied new cosmetics, dietary changes, or recent infections. Dermatology urgently assessed her, discontinued the new medication, and prescribed oral corticosteroids. Blood tests showed leukocytosis with neutrophilia and negative serology. Within 48 hours, symptoms improved. A biopsy confirmed Sweet syndrome.
Sweet syndrome (acute febrile neutrophilic dermatosis) is characterized by painful, erythematous plaques, systemic symptoms, and histological neutrophil infiltration. Common triggers include infections, neoplasms, autoimmune diseases, and medications. Although drug-induced forms are more common in women, there were no prior reports linking this condition to inhaled bronchodilators.
Differential diagnoses included urticaria, contact dermatitis, toxicoderma, and lupus, but were ruled out. This case emphasizes the need for primary care providers to consider rare dermatoses in drug reactions. Prompt recognition facilitates appropriate referrals, diagnosis, and systemic evaluation to exclude associated conditions like malignancies or autoimmune diseases.
