This case involves a 55-year-old woman with high blood pressure and COPD. She smoked 10 cigarettes daily and took enalapril for blood pressure along with formoterol, an inhaler for her lungs. When her lung symptoms worsened, her pulmonologist switched her to a different inhaler (indacaterol + glycopyrronium).

Just two days after starting the new inhaler, she developed painful red patches on her face and neck, along with a mild fever. No new skincare products, diet changes, or recent illnesses explained the reaction. Though she had been in the sun, she’d used proper protection.

Because of the sudden rash, doctors urgently referred her to dermatology. The dermatologist advised stopping the new inhaler and ordered a skin biopsy and blood tests. They also prescribed steroid pills, which quickly helped—within 24–48 hours, her pain eased, and the redness faded.

Test results showed high white blood cells (neutrophils) and signs of inflammation. Later, the biopsy confirmed Sweet syndrome, a rare skin disorder where neutrophils build up in the skin, causing painful rashes and fever. It can be triggered by infections, certain medications, or even cancer.

Key Signs of Sweet Syndrome:

Sudden, painful red/purple skin bumps or patches

Fever and high white blood cell counts

Fast improvement with steroids

Possible Causes:
While the exact cause is unclear, common triggers include:

Infections

Medications (e.g., antibiotics, birth control, or blood pressure drugs)

Rarely, underlying cancers

Treatment:
Steroids (pills or creams) work well—symptoms often improve within hours, and the rash clears in days.

Why This Case Matters:
This may be the first reported link between Sweet syndrome and this specific inhaler. Since the condition is rare, doctors might overlook it, but early recognition is key. Sweet syndrome can also signal other health issues (like infections or cancer), so further testing is important.