Remitting seronegative syndrome with pitting edema as the presenting symptom in a young, male patient with sarcoidosis: A case report

Abstract

Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) is a clinical diagnosis based on an abrupt onset of pitting edema of the dorsum of the hands or feet associated with synovitis of the wrist carpus and/or ankles, small joints, and tendon sheaths. RS3PE typically occurs in elderly patients, especially in men. A specific laboratory test for RS3PE syndrome is not yet available. However, recently published data provide evidence that color Doppler ultrasound (CDUS), contrast-enhanced CDUS, and magnetic resonance imaging are valuable tools in the diagnostic evaluation of involved anatomic structures in patients with RS3PE (1,2). Although idiopathic RS3PE has a benign prognosis with rapid and sustained response to low-dose steroid therapy, RS3PE may also be associated with different rheumatic and neoplastic diseases including myelodysplastic syndrome, non-Hodgkin’s lymphoma, T cell lymphoma, and chronic lymphocytic leukemia (3–11). The coincidence of RS3PE and sarcoidosis has been suggested in only one 62-year-old patient so far (12). Sarcoidosis is a chronic multisystemic disorder histologically characterized by noncaseating epithelioid cell granuloma (13). The lung is the most frequently affected organ ( 90%), but the skin, eyes, liver, and lymph nodes are also commonly involved (14). In this report, we describe the case of a 32-year-old man presenting with RS3PE syndrome. Further examinations led to the diagnosis of underlying sarcoidosis.