A woman with hypertension and COPD had been stable for years on enalapril and a formoterol inhaler. When her lung function worsened, doctors prescribed a new inhaler with “indacaterol and glycopyrronium” to improve breathing.

Just “48 hours after starting the new inhaler,” she developed painful red patches on her face and neck, a mild fever, and distressing skin symptoms. She was urgently referred to dermatology.

Doctors first suspected common issues like contact dermatitis, lupus, or hives. Blood tests and a skin biopsy, however, confirmed Sweet syndrome—a rare condition marked by sudden painful plaques, fever, and high white blood cell counts.

Treatment with corticosteroids brought rapid relief: “the plaques faded, the fever subsided, and her pain diminished rapidly” within two days. Sweet syndrome, usually linked to infections, cancer, or systemic drugs, had never before been tied to inhaled COPD medication.

This case highlights key lessons: no drug is risk-free, unusual rashes with fever should raise suspicion, and early biopsy plus corticosteroid therapy is essential. As the article concludes, “awareness is the first step toward prevention and improved outcomes.”