Unusual Case of Sweet Syndrome Triggered by New Inhaler Therapy in Primary Care

Sweet syndrome, also known as acute febrile neutrophilic dermatosis, is a rare inflammatory disorder characterized by the sudden onset of tender, erythematous skin lesions accompanied by systemic symptoms such as fever and malaise. Although it can be associated with infections, malignancies, and certain medications, its occurrence following inhaler therapy is exceedingly uncommon. This report describes an unusual case of Sweet syndrome potentially triggered by a new inhaler treatment in a primary care setting, emphasizing the importance of clinical awareness and early diagnosis.

Introduction

Sweet syndrome typically presents as painful, erythematous plaques or nodules on the face, neck, and upper limbs. Histopathologically, it is defined by dense dermal infiltrates of mature neutrophils without vasculitis.
Common drug triggers include granulocyte-colony stimulating factors, antibiotics, and certain antineoplastic agents. However, respiratory inhaler medications have rarely been implicated. This case highlights the diagnostic challenge and management of a patient developing Sweet syndrome shortly after initiating a new inhaler regimen.

A 42-year-old patient presented to their primary care clinic with a painful, raised, erythematous lesion on the forearm (see image) approximately one week after beginning a new combination inhaler containing a long-acting beta-agonist and corticosteroid for moderate asthma control.

The lesion began as a small erythematous papule, rapidly enlarging into a tender, well-demarcated, edematous plaque. The patient also reported low-grade fever, malaise, and joint stiffness, but denied respiratory infection, insect bites, or recent trauma.

Laboratory tests revealed:

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