Introduction
Sweet’s syndrome, also referred to as acute febrile neutrophilic dermatosis, is a rare inflammatory skin disorder. It is typically marked by the sudden appearance of painful, red to purple plaques or nodules, most often accompanied by systemic symptoms such as fever and malaise. Laboratory findings often reveal elevated white blood cell counts with neutrophilia, and a definitive diagnosis is usually confirmed through biopsy.
The condition may arise spontaneously, but it is frequently associated with underlying triggers such as infections, hematologic and solid malignancies, autoimmune conditions, and certain medications. Drug-induced Sweet’s syndrome, while less common, has been documented with agents including antibiotics, antiepileptics, and immunomodulatory therapies. This report describes an unusual presentation of Sweet’s syndrome that developed shortly after the initiation of a new inhaler in a primary care setting.
Case Presentation
A 58-year-old woman with a background of chronic asthma attended her primary care clinic with new symptoms that began a few days after starting a recently prescribed inhaler therapy. She reported persistent fever, generalized malaise, and the development of tender, erythematous plaques across her upper extremities and face.
On clinical examination, the lesions were raised, warm, and painful to touch, consistent with the typical cutaneous features of Sweet’s syndrome. Blood investigations demonstrated a marked leukocytosis with neutrophilia, further supporting an inflammatory process. The patient underwent a skin biopsy, which confirmed the diagnosis of acute febrile neutrophilic dermatosis.
Discussion
This case illustrates the potential for inhaler-based therapies, particularly those containing corticosteroids or other immunomodulatory compounds, to act as rare triggers for Sweet’s syndrome. Although inhaled corticosteroids are widely used and generally well tolerated in the management of asthma, their immunomodulatory effects may, in certain individuals, contribute to paradoxical inflammatory responses.
Drug-induced Sweet’s syndrome represents a diagnostic challenge in primary care, as its symptoms—fever, malaise, and skin changes—can easily be attributed to infection or other systemic illness. Awareness of this possibility is therefore crucial, especially when new therapies are introduced. Prompt recognition allows for early intervention, minimizing the risk of misdiagnosis and inappropriate treatment.
Management
The patient was referred to dermatology, where systemic corticosteroid therapy was initiated. Within 48 hours, she experienced a notable improvement in systemic symptoms, and the erythematous skin lesions began to regress. The case was further complicated by the fact that corticosteroids, while used therapeutically for Sweet’s syndrome, were also present in her inhaler regimen, raising important questions regarding drug-induced mechanisms.
After multidisciplinary review, the patient was advised to continue her inhaler therapy with close monitoring for recurrence. A tailored follow-up plan was established to track her skin condition and systemic health, ensuring any relapse would be detected early.
Conclusion
This report highlights an uncommon case of Sweet’s syndrome arising in a primary care setting after the initiation of inhaler therapy. Clinicians should remain alert to the possibility of drug-induced Sweet’s syndrome, particularly in patients presenting with new-onset painful skin lesions, fever, and leukocytosis shortly after starting a new medication.
Early recognition, specialist referral, and timely management with systemic corticosteroids are essential to achieving rapid recovery and preventing complications. This case reinforces the importance of maintaining a broad differential diagnosis when evaluating patients with unusual dermatologic and systemic presentations in routine primary care.
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