When a middle-aged woman developed painful facial rashes after starting new COPD medication, her doctors initially suspected a typical drug allergy. But the case took an unexpected turn when tests revealed Sweet syndrome – a rare inflammatory condition that’s more than skin deep.
The patient, a long-time smoker with well-controlled hypertension and COPD, had recently switched inhaler medications under her pulmonologist’s guidance. Within 48 hours, angry red patches appeared on her face and neck, accompanied by low-grade fever. Crucially, she hadn’t introduced any new skincare products, changed her diet, or experienced recent infections.
Dermatologists identified several telltale signs of Sweet syndrome: the sudden onset of tender, asymmetrical lesions; fever; and blood work showing elevated neutrophils. The skin biopsy provided definitive confirmation. What’s fascinating about this case is the clear connection to the new inhaler medication – a trigger not previously documented in medical literature.
Sweet syndrome represents an overactive immune response where neutrophils (a type of white blood cell) infiltrate the skin. While the exact mechanism remains unclear, researchers believe certain medications can trigger this abnormal reaction in susceptible individuals. The good news? Symptoms typically resolve quickly with corticosteroids, as seen with this patient.
This case underscores why healthcare providers should maintain a high index of suspicion for Sweet syndrome when patients develop these characteristic symptoms after medication changes, even with drugs not previously associated with the condition.
