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What made this case unusual was that inhaled bronchodilators like indacaterol or glycopyrronium had not previously been associated with Sweet syndrome. Although drug-induced cases are more commonly reported in women, this medication class was a novel trigger, making the case clinically important.

The diagnosis required careful exclusion of similar conditions, such as urticaria, allergic contact dermatitis, toxic drug eruptions, lupus, and other inflammatory or autoimmune skin disorders. Each was ruled out based on clinical presentation, lab results, histology, and rapid improvement after stopping the suspected drug.

This case underscores a key lesson for clinicians, especially in primary care and pulmonology: even medications with established safety profiles can rarely cause severe reactions. When new symptoms appear soon after starting a medication—particularly with systemic signs like fever and inflammation—a drug reaction should be strongly considered.

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