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Sweet Syndrome, also known as acute febrile neutrophilic dermatosis, is a rare inflammatory skin disorder with systemic manifestations. Although uncommon, it is critical for primary care physicians to recognize its clinical signs and consider it during differential diagnosis—especially when symptoms rapidly follow medication changes.
This article outlines a documented clinical case and offers a comprehensive review of Sweet Syndrome, including its presentation, diagnostic criteria, treatment, and clinical significance, particularly in relation to medication-induced reactions.
Clinical Case Summary
A 55-year-old female patient with a medical history of hypertension and chronic obstructive pulmonary disease (COPD) presented with erythematous, painful facial and neck lesions accompanied by low-grade fever. She had no known allergies and reported smoking approximately 10 cigarettes daily.
Her regular medication regimen included:
Enalapril (6 years)
Inhaled formoterol (2 years)
Due to a deterioration in pulmonary function, her pulmonologist replaced formoterol with a combination of indacaterol and glycopyrronium in capsule inhaler form.
On the second day of the new therapy, the patient developed painful, reddish skin lesions on her cheeks and neck, prompting a visit to her primary care clinic. She denied recent upper respiratory infection symptoms, had used appropriate sun protection, and made no changes to her diet or cosmetic routine.
This case highlights the rare occurrence of Sweet Syndrome following inhaled bronchodilator therapy—specifically, a combination of indacaterol and glycopyrronium, which has not previously been reported in medical literature as a trigger for this condition.
What Is Sweet Syndrome?
Sweet Syndrome is classified among neutrophilic dermatoses. It typically presents with:
Painful erythematous plaques or nodules
Sudden onset
Fever
Leukocytosis
The lesions are often bilaterally distributed and asymmetrical, typically affecting the face, neck, upper trunk, and extremities.
Common Symptoms:
Low-grade to moderate fever
Painful skin lesions (papules or plaques)
Fatigue or malaise
Joint pain or ocular symptoms (in some cases)
Diagnostic Criteria for Sweet Syndrome
According to Su and Liu (1986) and updated clinical guidelines, the diagnosis is made using a combination of major and minor criteria:
Major Criteria:
Abrupt onset of painful erythematous plaques or nodules
Histopathology showing dense neutrophilic infiltrate without vasculitis
Minor Criteria (at least two required):
Though rarely associated, this case introduces a potential link between inhaled long-acting bronchodilators and Sweet Syndrome, emphasizing the need for ongoing pharmacovigilance and clinician awareness.
Johnson Pushes Back on ‘War Powers’ Vote Amid Iran Strikes
Speaker Mike Johnson (R-La.) said on Monday that passing a war powers resolution would strip President Trump of his authority to continue military operations in Iran, warning that such a move would present a “frightening prospect.”
Representatives Ro Khanna (D-Calif.) and Thomas Massie (R-Ky.) plan to push for a vote on a war powers resolution this week, which would require Congressional authorization before Trump can use military force against Iran again. They argue that the operations in Iran put U.S. troops at risk and are not representative of an “America First” agenda.
According to a source who spoke to The Hill, the resolution is expected to be brought to the floor on Thursday.
“I think the idea that we would move a War Powers Act vote right now, I mean, it will be forced to the floor, but the idea that we would take the ability of our commander in chief, the president, take his authority away right now to finish this job, is a frightening prospect to me,” Johnson told reporters after a briefing on the operation.
“It’s dangerous, and I am certainly hopeful, and I believe we do have the votes to put it down. That’s going to be a good thing for the country and our security and stability,” he added.
The U.S. and Israel conducted joint military strikes against Iran on Saturday after weeks of threats from Trump, who had called for regime change in Tehran. Johnson wrote on the social platform X that Congress’s bipartisan “Gang of Eight” was “briefed in detail earlier this week that military action may become necessary to protect American troops and American citizens in Iran.”
On Monday, Secretary of State Marco Rubio said that the Iranian military and regime were racing to achieve “immunity” for its ongoing nuclear weapons program, meaning the ability to develop enough ballistic missiles to shield itself and the program from destruction. That’s why Trump chose to act now, he added.
Trump told CNN on Monday morning that the “big wave” of the operation is yet to come. When he was asked how long the war will last, the president said, “I don’t want to see it go on too long. I always thought it would be four weeks. And we’re a little ahead of schedule.”
On Monday, Johnson told reporters he believes Trump “was acting well within his authority” as commander-in-chief to protect the country.
“It’s not a declaration of war. It’s not something that the president was required, because it’s defensive in nature and in design and in necessity, to come to Congress and get a vote first. And if they had briefed a larger group than the Gang of Eight, you know, there’s a real threat that that very sensitive intelligence that we had, you know, might have been leaked or something,” he said.
“So, this is why the commander in chief of our armed forces has the latitude that any commander in chief, any president always has, because they have a set of information that is sensitive, timely and urgent, and they have to be able to act upon it. They did that.”
House Minority Leader Hakeem Jeffries (D-N.Y.) has urged lawmakers to support the war powers resolution, stating in a CNN interview on Monday that Trump needs to be constrained.
Presidents from both parties have taken action on behalf of the country in the past. Also, every president since the act was passed in the early 1970s has said they believe it unconstitutionally limits a president’s Article II authorities.
Trump Escalates Criticism of Ilhan Omar While Aboard Air Force One
What began earlier this month as a viral White House jab at Rep. Ilhan Omar (D-MN) has now turned into a broader campaign offensive, with President Donald Trump doubling down on his criticism of the Somali-born congresswoman and the Somali refugee community in the United States.
Omar said during an October appearance on The Dean Obeidallah Show that she was not worried about losing her U.S. citizenship or being sent back to Somalia, where she was born.
“I have no worry, I don’t know how they’d take away my citizenship and like deport me,” Omar said. “But I don’t even know why that’s such a scary threat. I’m not the 8-year-old who escaped war
anymore. I’m grown, my kids are grown. I could go live wherever I want.”
On Nov. 10, the White House posted on X a 2024 photo of Trump waving from a McDonald’s drive-thru window, replying to a clip in which Omar said she was unconcerned about being deported.
The photo — taken during a campaign stop in Pennsylvania — quickly circulated online and was widely interpreted as a taunting “good-bye” message aimed at the Minnesota lawmaker.
Now, the feud has reignited. Speaking to reporters aboard Air Force One, Trump referenced the allegation that Omar had entered the U.S. through a fraudulent marriage.
“She supposedly came into our country by marrying her brother,” he said. “If that’s true, she shouldn’t be a congresswoman, and we should throw her the hell out of the country.”
The president also broadened his remarks to criticize Somali immigration overall.
“Somalis have caused us a lot of trouble, and they cost us a lot of money,” Trump said. “What the hell are we paying Somalia for? We have Ilhan Omar who does nothing but complain about our Constitution and our country! We’re not taking their people anymore — in fact, we’re sending them back.”
Trump has often accused Omar of being “anti-American,” previously telling her and other progressive “Squad” members to “go back” to their “broken and crime-infested countries.” Omar responded earlier this month by calling Trump a “lying buffoon” and saying his story about Somalia’s president refusing to take her back was fabricated.
The White House has signaled that it will not walk back the president’s latest statements. A senior aide said Trump was “reminding voters that America’s generosity should never be repaid with contempt.”
Omar’s family fled Somalia’s civil war in 1991 and spent several years in a Kenyan refugee camp before settling in the United States. She was elected to Congress in 2018, becoming one of the first Muslim women and the first Somali-American to serve in the U.S. House of Representatives.
The renewed confrontation underscores the political tension between Trump and radical members of the “Squad.” It comes amidst growing concerns about immigration policy and the vetting of immigrants in the aftermath of an Afghan refugee’s shooting of two National Guard members over the Thanksgiving holiday.
Gorsuch Warns Lower Courts After Repeatedly Ignoring Supreme Court Rulings
A Supreme Court justice appointed by President Donald Trump is fed up. Justice Neil Gorsuch on Thursday blasted lower courts for repeatedly defying rulings from the highest court in the land, as the justices handed the Trump administration a narrow victory in a case over federal research grants.
In a 5-4 decision, the Court allowed the administration to cut millions of dollars in National Institutes of Health (NIH) grants that supported projects tied to diversity, equity and inclusion (DEI) initiatives, gender identity research, and COVID-19. The NIH, the world’s largest source of public biomedical research funding, will no longer award grants based on race or DEI objectives under the ruling, The Daily Caller reported.
“This marks the third time in a matter of weeks this Court has had to reverse a lower court on an issue it had already addressed,” Gorsuch wrote, joined by Justice Brett Kavanaugh. “Lower court judges may sometimes disagree with this Court’s decisions, but they are never free to defy them.”
The case arose after a federal judge in Massachusetts ordered the government to continue payments despite a Supreme Court ruling earlier this year permitting Trump to cut similar DEI-related grants. A coalition of 16 Democratic attorneys general and public health groups sued, alleging discrimination.
Justice Amy Coney Barrett provided the deciding vote. She joined conservative Justices Clarence Thomas, Samuel Alito, Gorsuch and Kavanaugh in terminating the NIH grants, but sided with Chief Justice John Roberts and the three liberal justices — Sonia Sotomayor, Elena Kagan and Ketanji Brown Jackson — to leave intact a lower court’s decision scrapping NIH guidance documents that described the agency’s policy priorities.
Gorsuch stressed that the district court’s actions were not a “one-off,” pointing to two other recent cases where lower courts resisted Supreme Court orders.
In July, the justices ruled 7-2 to block a district court’s attempt to override the high court’s order allowing Trump to resume third-country deportations. Even Justice Elena Kagan, who had dissented from the original ruling, sided with the majority to enforce the order.
“I do not see how a district court can compel compliance with an order that this Court has stayed,” she wrote.
That same month, the high court struck down another lower court ruling that sought to block Trump from firing three Democratic members of the Consumer Product Safety Commission (CPSC). The justices had already granted Trump authority in May to dismiss members of administrative agencies.
“All these interventions should have been unnecessary, but together they underscore a basic tenet of our judicial system: Whatever their own views, judges are duty-bound to respect ‘the hierarchy of the federal court system created by the Constitution and Congress,’” Gorsuch wrote.
Since returning to office in January 2025, Trump has signed executive orders dismantling Biden-era DEI programs, calling them “radical” and “shameful discrimination.” Last April, the Court upheld Trump’s authority to cut teacher training grants linked to DEI, a precedent Gorsuch said the Massachusetts court ignored in this NIH case.
Since the ruling halts immediate funding, the administration is likely to count it as another win in the series of emergency appeals it has brought to the high court.
In a concurring opinion, Barrett wrote that the case should have been filed in the U.S. Court of Federal Claims in Washington rather than in a district court. That court hears disputes involving federal contracts and could award damages later, but would not provide immediate relief.
The decision reversed U.S. District Judge William Young, a Reagan appointee, who in June ordered NIH to restore the grants after lawsuits from researchers and 16 Democratic-led states. Young used unusually sharp language, declaring: “This represents racial discrimination and discrimination against America’s LGBTQ community. I would be blind not to call it out. My duty is to call it out.”
It is unclear why the judge legally compelled the Trump administration to fund programs to “raise awareness” about LGBTQ issues or why that is tantamount to “discrimination.”
