“These are the signs that he is cr…See moree”

This article presents a medical case emphasizing why both patients and healthcare providers must stay alert to subtle bodily changes—especially after adjusting medications. 

The Patient’s Journey: From Stability to Sudden Symptoms

• A patient with hypertension and chronic obstructive pulmonary disease (COPD) was stable on enalapril and a formoterol-based inhaler. 
• When lung function declined, her pulmonologist switched her to a new inhaler containing indacaterol and glycopyrronium. 
• Within 48 hours of starting the new inhaler, she developed painful, bright red patches on her face and neck and a mild fever—without any new cosmetics, diets, or illnesses noted. 

The Diagnostic Process: Uncovering Sweet Syndrome
• Initial diagnoses included contact dermatitis, lupus erythematosus, and urticaria. 
• After ruling out infections and autoimmune markers, the inhaler was discontinued. A skin biopsy confirmed the diagnosis of Sweet syndrome (acute febrile neutrophilic dermatosis). 
• Treatment with oral corticosteroids led to dramatic improvement within two days: the rash faded, fever subsided, and pain lessened.