The following is a clinical case of a dermatological disease with systemic repercussions that should be taken into account in the Primary Care consultation.

This is a 55-year-old woman with a medical history of high blood pressure and COPD. She had no allergies, smoked 10 cigarettes a day, and had been on regular treatment with enalapril for the past 6 years and inhaled formoterol for the past 2 years. Due to a worsening of her lung disease, the pulmonologist decided to reinforce her inhalation treatment by discontinuing formoterol and prescribing a combination of indacaterol and glycopyrronium inhaled capsules.

She attended the Primary Care clinic because, on the second day of the new inhaler treatment, she developed painful, erythematous patches on her cheeks and neck, accompanied by a low-grade fever (Fig. 1). The patient denied using any new cosmetics, had not made any changes to her usual diet, and did report sun exposure, albeit with adequate protection. She had not experienced any catarrhal symptoms in the previous days.

An urgent referral to Dermatology was decided for evaluation of the lesions. After being seen by the Dermatology Department, the patient was advised to discontinue the new medication, and a biopsy and blood tests were performed, including a complete blood count, antibodies, lupus anticoagulant, and serology tests. Oral corticosteroids were prescribed.

After 24-48 hours, the lesions diminish in intensity and the pain subsides. Blood tests reveal the presence of leukocytosis with neutrophilia, antibodies, lupus anticoagulant, and negative serology results.

Twenty days later, the results of the skin biopsy arrived and were positive for Sweet syndrome.

Sweet syndrome (also known as acute febrile neutrophilic dermatosis) is a dermatological disease classified within neutrophilic dermatoses, since histopathologically it is characterized by the presence of neutrophil infiltrates 1 .

Clinically, it is characterized by the appearance of lesions in the form of erythematous papules or plaques distributed bilaterally, usually asymmetrical, with a sudden onset and pain. The most common locations are the face, neck, upper trunk, and hands. It is also characterized by the presence of systemic symptoms (fever, leukocytosis with neutrophilia, etc.) 2  (Table 1) 1,3 .Table 1.

Diagnostic criteria for Sweet syndrome

The etiology of Sweet syndrome is not known with certainty. According to some studies, the pathogenesis is mediated by cytokines involved in the chemotaxis and activation of neutrophils and histiocytes 4,5 . A hypersensitivity reaction is presumably triggered by a previous process, such as an upper respiratory tract infection or paraneoplastic processes, and also by the intake of medications 2,6,7 . Diagnosis is important, since it requires ruling out systemic disease, such as atypical forms of Sweet syndrome on the back of the hands, which may be the main sign of occult neoplastic diseases 8 .

In cases secondary to drugs or idiopathic, it is more frequent in the female sex 2 .

The drugs most frequently shown to be correlated with Sweet syndrome are contraceptives, antiepileptics, antibiotics, antihypertensives, colony-stimulating factors, and vaccines 6 . However, these drugs are not the only ones that are exclusivity-related, which is why we have presented this clinical case.

The first-line treatment for Sweet’s syndrome is oral corticosteroids, which respond rapidly, so that general discomfort and pain subside within the first few hours and the lesions disappear in less than a week 2 .

In this case of sudden onset of erythematous papular lesions on the face and neck, a differential diagnosis must be made with urticaria, contact dermatitis, and toxicoderma due to the appearance of the lesions, and with cutaneous lupus due to the characteristics of the lesions. Once all of these were ruled out based on the history and the results of complementary tests, and thanks to the conclusive diagnosis of the biopsy, the patient was diagnosed with Sweet syndrome.

Sweet’s syndrome can be induced by a large number of drugs and should be considered as a diagnostic option, especially if the relationship between drug exposure and the appearance of the lesions is clear. To date, there are no reported cases of Sweet’s syndrome secondary to inhalant therapy, making this the first; hence the importance of considering other drugs, even though they have not been described in the literature.

Since it is a rare disease, it is not usually established as a differential diagnosis at first, but it should be taken into account, especially because it can also involve not only the skin but also internal organs, being a marker of infections, inflammatory bowel disease, autoimmune connective tissue diseases, and malignant neoplasms, especially those of hematological origin.

Therefore, it is essential that after diagnosing Sweet syndrome, the study be completed to rule out associated organic conditions, such as tumors, rheumatic diseases, or infections.

Primary care physicians should consider all diagnostic possibilities, even if the diagnosis cannot be defined in the office. A primary care physician’s knowledge of rare diseases leads to early and correct referrals, enabling timely diagnosis and treatment.

Ethical Responsibilities Protection of People and Animals

The authors declare that no experiments were performed on humans or animals for this research.

Data confidentiality

The authors declare that they have followed their workplace protocols regarding the publication of patient data.

Right to privacy and informed consent

The authors have obtained informed consent from the patients and/or subjects mentioned in the article. This document is in the possession of the corresponding author.

Understanding and Managing Bites from Black Widow and Brown Recluse Spiders

When it comes to spider bites, two species stand out due to the potential dangers they pose: the Black Widow spider (genus Latrodectus) and the Brown Recluse spider (genus Loxosceles). Both have venom that can lead to serious medical conditions, necessitating swift action and appropriate medical intervention. In this comprehensive guide, we delve into how to identify these spiders, what to do in the event of a bite, and most importantly, how to prevent these potentially dangerous encounters. Understanding these factors is crucial not only for individual safety but also for promoting a wider awareness of the ecological roles these spiders play.

Identifying the Culprits: Black Widow and Brown Recluse Spiders

Understanding the physical characteristics of these spiders is crucial for identification and subsequent prevention. The Black Widow spider is easily recognized by its glossy black exterior and the distinctive red hourglass shape on the underside of its abdomen. This species is primarily nocturnal and often seeks refuge in undisturbed areas such as woodpiles, corners of garages, and sheds. Notably, female Black Widows are significantly larger than males and are more likely to bite when they feel threatened. Initially, a bite from a Black Widow may not trigger immediate pain, but it can escalate quickly, typically manifesting intense pain, muscle cramps, sweating, nausea, and in severe cases, difficulty breathing within 15 to 60 minutes. The severity of the symptoms can vary depending on the individual’s health and the amount of venom injected.

In contrast, the Brown Recluse spider is usually brown and can be identified by a violin-shaped marking on its dorsal side, which is often visible upon close examination. This spider prefers secluded, dark environments, often hiding in storage bins, closets, and even under beds. Like the Black Widow, the Brown Recluse is shy and will only bite when provoked. Initially, the bite may be painless, leading many people to be unaware that they have been bitten. However, over time, the bite can lead to severe symptoms such as necrosis (tissue death), fever, chills, and systemic reactions. Identifying these signs early is vital for timely intervention, as the progression of symptoms can escalate rather quickly without proper treatment.

Steps to Take if You Are Bitten

If you suspect that you have been bitten by either a Black Widow or a Brown Recluse spider, your immediate response can significantly influence the outcome. First and foremost, it’s essential to remain calm. Panic can accelerate the spread of venom throughout the body. Your next steps should include:

• Clean the wound: Gently wash the affected area with soap and water to minimize the risk of infection. This step is critical, as it can help prevent secondary infections that can complicate recovery.
• Apply cold therapy: Use a cold compress or ice wrapped in a cloth on the bite area for about 10 minutes to alleviate swelling and pain. This can help reduce the initial inflammatory response.
• Restrict movement: If the bite is on a limb, keep the affected arm or leg as still as possible to slow the absorption of venom. Immobilizing the limb can be crucial in preventing the venom from spreading too quickly.
• Seek medical attention: It is crucial to visit an emergency room or contact emergency services immediately. Medical professionals can provide appropriate treatments, such as pain relief medications and, if necessary, antivenom.

Treatment and Recovery Options

The treatment approach for bites from these spiders varies based on the severity of symptoms. For Black Widow spider bites, healthcare providers may administer an antidote known as Antivenin if the symptoms are particularly severe. Patients might also receive muscle relaxants and pain medications to alleviate discomfort. The treatment may include intravenous fluids to hydrate the patient and monitor vitals closely for any signs of systemic reactions.

In the case of Brown Recluse spider bites, the primary focus is managing symptoms. Doctors may prescribe corticosteroids to reduce inflammation and antibiotics to prevent secondary infections, particularly if necrosis is present. In severe cases, surgical intervention may become necessary to remove necrotic tissue. It’s crucial to avoid home remedies such as attempting to suck out the venom or applying heat directly to the bite, as these can exacerbate the condition. Recognizing the symptoms and seeking timely treatment are the keys to a successful recovery.

Preventive Measures to Avoid Spider Bites

Prevention is always better than cure, particularly when dealing with the risks associated with venomous spiders. Implementing strategies to minimize the risk of spider bites is essential. Here are several effective measures:

• Maintain a clean environment: Regularly clean and declutter your home, focusing on dark corners and areas where spiders might thrive. By reducing clutter, you can eliminate potential nesting sites.
• Inspect clothing and bedding: Always shake out clothes, shoes, and bedding before using them, especially items that have been stored away for a while. This simple habit can help remove any lurking spiders.
• Wear protective gear: When handling items in storage or working in areas where spiders may reside, wearing gloves can help protect your skin from bites. Additionally, wearing long sleeves and pants can provide extra protection.
• Seal entry points: Inspect your home for cracks and gaps in walls, windows, and doors. Sealing these openings can help prevent spiders from entering your living space. Consider using caulking or weather stripping to create a more spider-proof environment.
• Use pest control strategies: If you reside in areas prone to these spiders, consider consulting pest control professionals who can provide effective solutions to keep these arachnids at bay.

Conclusion: Staying Informed and Prepared

Bites from the Black Widow and Brown Recluse spiders can be dangerous, yet they do not need to lead to severe health issues if addressed promptly and effectively. By familiarizing yourself with the characteristics of these spiders, knowing the immediate steps to take in the event of a bite, and implementing preventive measures, you can significantly reduce the likelihood of encountering these arachnids. Education and awareness are your best allies in preventing spider bites and ensuring that you remain safe in your surroundings. Remember, while these spiders contribute to the ecological balance by controlling insect populations, being informed and prepared is your strongest defense in managing any potential risks associated with their presence.

I never imagined I’d become the kind of woman who installs hidden cameras on her own property. That used to sound like something from a thriller novel or a true crime podcast—paranoid, desperate, even a little unhinged. But when your intuition whispers for long enough, you start to listen. Especially when your husband's frequent "business trips" start overlapping with small, strange details that don’t quite add up. And especially when a call from an old neighbor unearths something your gut already knew: something isn’t right.

Luke and I had what outsiders would call the perfect marriage. Picture-perfect, really. We were the couple everyone rooted for at parties, the ones who moved in rhythm without trying, finishing each other’s sentences and smiling like it came easy. For seven years, we shared laughter, supported each other’s careers, and made vague, beautiful promises about starting a family “one day.” I, a senior editor at a publishing firm, threw myself into work without realizing how convenient my busyness had become—for him. 

It was a Tuesday afternoon when Mr. Jensen, my late grandmother’s old neighbor, called. His voice was slow, the kind of careful that comes with age and uncertainty. He said he’d seen a tall man with dark hair unlocking the front door of my grandmother’s lake house. The same lake house I inherited years ago, the one Luke never had a key to. The man wasn’t alone. He was with a blonde woman.

“You said your husband was out of town, right?” he asked gently. 

“He is,” I replied, though the words caught in my throat. Luke had told me he was in Philadelphia for a marketing conference that weekend. Something inside me—the part I’d trained to stay quiet—screamed awake. 

The next time he left on a “trip,” I didn’t go to the office. I drove straight to the lake house. I’d barely parked when the first red flag hit me: a wine glass sitting in the sink, stained with lipstick. The second was a long blonde hair curled near the bathroom drain. And then, the takeout containers—two sets of chopsticks, neatly placed like a dinner for two. I stood there, stomach tight, heart pounding with the kind of betrayal that doesn’t make sense at first. 

But I didn’t confront him. Not yet. 

Instead, I did something I never thought I’d do. I bought and installed a set of hidden cameras—discreet, motion-activated, and synced to my phone. I told myself I needed proof. Closure. Something more than lipstick and a neighbor’s memory. I told myself I wasn’t going crazy. 

Days later, the footage came in. 

There he was. Luke. My husband. Laughing as he unlocked the front door like it was his. And beside him, a woman with long blonde hair, dressed like she belonged. “Welcome back to paradise, babe,” he said, his voice smooth and familiar. He kissed her as they walked inside. 

I didn’t cry. 

I planned. 

When Luke mentioned another trip the following week, I smiled and suggested a change of pace—just the two of us. A spontaneous romantic weekend at the lake house, “like old times.” He looked startled, then hesitant. But I had already confirmed with his coworker that he had no trips planned. I had him. 

At the lake, after a breezy lunch on the porch and a glass of wine he didn’t deserve, I told him I had a surprise. He smiled—nervous, perhaps. Expecting maybe a gift, or a memory. Instead, I picked up the remote and hit play. 

The footage lit up the screen. 

There was his face, full of affection—for someone else. Her laugh, her presence, the way he held her like it was second nature. The words he used to use on me, spoken to a stranger in our sacred space.

His face went pale. “You spied on me?” he barked, his voice rising with disbelief, anger, guilt. Gaslighting 101. 

I didn’t flinch. I reached into my bag and handed him a folder. Divorce papers. 

“You have until Monday to sign,” I said evenly. “If you don’t, this footage goes to your boss. And her husband.” 

He didn’t argue. He left that day. 

That night, alone in the silence of the lake house, I wrapped myself in my grandmother’s old quilt. The fabric smelled faintly of lavender and firewood. I sat on the porch, legs tucked beneath me, and watched the sun dip below the horizon. The air was still. The kind of stillness that follows a storm. 

It was the first time in weeks I could finally breathe.

Jennifer Aniston has long been one of Hollywood’s most beloved actresses, known for her charm, grace, and humor in both television and film. However, one of her past talk show appearances has resurfaced, sparking renewed discussions about interview etiquette and the evolving standards of late-night television. 

A Memorable Interview with David Letterman

In 1998, Jennifer Aniston appeared on The Late Show with David Letterman to promote her film The Object of My Affection. While interviews with Letterman were known for their witty banter and playful exchanges, this particular interaction took an unexpected turn, leaving both Aniston and the audience slightly surprised.

During the conversation, Letterman abruptly leaned toward Aniston and, in a moment that many found unusual, took a strand of her hair and placed it in his mouth. The actress, caught off guard, reacted with a mix of laughter and confusion, saying, “What are you doing?” The moment was met with nervous chuckles from the audience, but Aniston’s facial expression showed clear surprise.

Letterman then handed her a tissue, prompting her to wipe the strand of hair. She accepted it, responding with good humor despite the unexpected situation, saying, “That was something I’ll never forget.” The interview continued, and Aniston handled the moment with her signature poise and professionalism.

Revisiting the Interview in Today’s Context

Over the years, late-night television has evolved significantly, reflecting changes in audience expectations and cultural awareness. This particular moment with Aniston has resurfaced on social media, leading to discussions about how interview dynamics have changed over time.

While interviews in the 1990s often featured a more spontaneous and unpredictable style, today’s conversations tend to be more structured and considerate of personal boundaries. Looking back, many viewers have reevaluated moments like this through a modern lens, emphasizing the importance of mutual comfort and respect in public interactions. 

Aniston’s Grace and Professionalism

One of the reasons Jennifer Aniston remains such a well-respected figure in Hollywood is her ability to navigate all kinds of situations with humor and professionalism. Whether in interviews, public appearances, or her film and television roles, she has consistently maintained a warm and engaging presence.

Following this interview, Aniston continued to appear on The Late Show with David Letterman multiple times over the years, demonstrating her ability to move past awkward moments and maintain strong professional relationships within the industry.

The Evolution of Talk Show Culture

The landscape of talk shows has shifted over the decades, with hosts and producers becoming more attuned to the importance of guest comfort and audience perception. While spontaneity remains an essential element of entertainment, modern interview formats prioritize creating a positive and respectful atmosphere for guests.

Many talk show hosts today focus on ensuring that conversations remain engaging while also being mindful of personal boundaries. The rise of social media has also played a role in this shift, as interviews are now scrutinized in real-time, often sparking immediate reactions and discussions among viewers.

The Enduring Popularity of Jennifer Aniston Despite changing times and evolving media standards, Jennifer Aniston remains one of the most admired figures in Hollywood. From her breakthrough role as Rachel Green on Friends to her recent work in The Morning Show, she has continually demonstrated her versatility and resilience in the entertainment industry.

Her ability to handle all types of interviews with poise and humor is a testament to her professionalism. Moments like the 1998 Late Show appearance serve as reminders of how the entertainment industry has grown and adapted, leading to more thoughtful and considerate conversations on screen.

Final Thoughts

Looking back at this interview, it’s clear that the world of late-night television has evolved. What was once considered lighthearted banter is now viewed through a different cultural lens, emphasizing the importance of creating a comfortable and respectful environment for all guests.

Jennifer Aniston’s enduring charm and professionalism continue to make her a favorite among fans and interviewers alike. As talk shows continue to adapt, they reflect broader changes in media and societal expectations, ensuring that entertainment remains enjoyable for everyone involved.

Somewhere in the heart of Dubai, among the glass and steel towers, where every street discharges luxury and the air smells of money, there was a restaurant called the Pearl of the Orient.