Most patients with chronic respiratory diseases like COPD rely on inhaler therapy to maintain quality of life. These medications are considered safe and effective, with side effects usually limited to common issues such as throat irritation or coughing. However, a rare case recently reported in primary care has raised important questions about unexpected risks. A woman developed Sweet syndrome, an uncommon skin disorder, shortly after beginning a new inhaler treatment. This case may represent one of the first times inhaled therapy has been implicated in triggering the condition.
Case Presentation
A 55-year-old woman with hypertension and COPD, stable on enalapril and formoterol, was switched to indacaterol–glycopyrronium. Within 48 hours, she developed painful red plaques on her face and neck, plus a low-grade fever. With no other triggers identified, her inhaler was discontinued, and she was urgently referred to dermatology.
Diagnostic Findings
Blood tests excluded infection and autoimmunity, but a skin biopsy confirmed Sweet syndrome, a rare inflammatory disorder. It explained her painful red plaques, fever, and tenderness. She responded rapidly to oral corticosteroids, with symptoms easing in two days. Sweet syndrome often follows infections, cancers, or medications, requiring prompt recognition and treatment.
Why This Case Is Unique
This case is significant due to a suspected link between inhaled COPD therapy and Sweet syndrome—previously seen only with oral or injectable drugs. It suggests inhaled particles may rarely trigger systemic immune reactions. Early recognition by primary care was crucial, ensuring rapid referral, accurate diagnosis, and effective treatment.
Broader Implications for Clinicians
While this appears to be a rare occurrence, the case underscores important clinical lessons:
- Stay alert after medication changes. Any new or worsening skin eruption within days of starting a drug should be carefully documented and investigated.
- Think beyond common side effects. Even familiar medications like inhalers can rarely trigger unexpected immune responses.
- Early referrals matter. Dermatology input and biopsy results were crucial in reaching the correct diagnosis.
- Educate patients. Encouraging patients to report unusual reactions promptly can help prevent delays in treatment.
Conclusion
This rare case of Sweet syndrome after inhaler use underscores the need for vigilance in prescribing and monitoring. While inhaled therapies are generally safe, unusual adverse events can occur. Recognizing atypical triggers aids timely diagnosis, while patient communication about new symptoms ensures swift, effective care and improved outcomes.
