The case presented is a powerful example of a rare but important condition known as Sweet Syndrome (Acute Febrile Neutrophilic Dermatosis). This serves as a critical alert for both patients and healthcare providers, illustrating how a new medication can trigger a rapid and systemic reaction with distinct dermatological signs.
Summary of the Clinical Case: A Medication-Induced Reaction
A 55-year-old female with a history of hypertension and COPD switched her inhaler medication to a new combination drug (indacaterol/glycopyrronium). Within 48 hours, she developed:

Painful, red patches on her cheeks and neck.

Low-grade fever.

No other common triggers (new cosmetics, diet changes, or recent infection).

Key Actions Taken:

Urgent Dermatology Referral: Immediate specialist evaluation.

Drug Discontinuation: The new inhaler was stopped.

Biopsy & Blood Tests: Confirmed the diagnosis.

Treatment: Oral corticosteroids were started.

Result: Lesions and pain improved within 24-48 hours of stopping the drug and starting treatment. Blood tests showed leukocytosis with neutrophilia (high white blood cell count with high neutrophils). A skin biopsy confirmed Sweet Syndrome.

The 4 Cardinal Signs of Sweet Syndrome
This case perfectly illustrates the classic tetrad of symptoms. Be alert if these signs appear suddenly, especially after a new medication, infection, or in the context of an underlying inflammatory condition or malignancy.

1. Sudden, Painful Skin Lesions