Authors
P Baburaj, Reshma PK, Shankar BV1
1Department of Internal Medicine, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala.
Abstract
Background: Remitting seronegative symmetrical synovitis with pitting oedema (RS3PE) is a rare inflammatory arthritis that can occur idiopathically or as a paraneoplastic manifestation of an underlying malignancy. Early recognition of its paraneoplastic nature is crucial for timely diagnosis and management of associated internal malignancies.
Case Presentation: We report the case of a 62-year-old male, a chronic smoker and alcoholic, who presented with swelling of both hands and feet for two months, along with normocytic anaemia and elevated acute phase reactants. He was diagnosed with remitting seronegative symmetrical synovitis with pitting oedema based on clinical and laboratory findings, including negative rheumatoid factor. Further imaging studies, prompted by the possibility of paraneoplastic manifestation, revealed a large peripheral mass in the right upper lobe of the lung. A CT-guided biopsy confirmed adenocarcinoma. The final diagnosis was RS3PE associated with adenocarcinoma of the right lung.
Conclusion: This case underscores the importance of a comprehensive diagnostic work-up to rule out underlying malignancy in patients presenting with RS3PE, particularly in older individuals with risk factors, to ensure prompt referral for oncological management.