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A 55‑year‑old woman with hypertension and chronic obstructive pulmonary disease (COPD) faced an unexpected turn after her inhaler therapy was changed. Previously stable on enalapril and formoterol, her pulmonologist switched her to a new combination inhaler with indacaterol and glycopyrronium. Just 48 hours later, she developed intense, painful red plaques on her face and neck and a low‑grade fever.
Despite no recent changes in cosmetics or diet—and no signs of infection—a skin biopsy revealed an unexpected diagnosis: Sweet syndrome, a rare immune‑mediated skin disorder. What makes this case extraordinary is that it appears to be the first documented trigger of Sweet syndrome caused by an inhaled medication. Treatment involved discontinuing the inhaler and initiating oral corticosteroids, leading to rapid symptom resolution within 48 hours.
Sweet syndrome is characterized by sudden onset of painful, red skin lesions, fever, and elevated neutrophils. Common triggers include infections, malignancies, and certain medications — but inhalers have been virtually absent from prior reports. This case highlights the need for healthcare providers to remain vigilant for atypical reactions when introducing new therapies, even ones perceived as low‑risk. Prompt recognition and specialist referral can make all the difference.
