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Case report
Remitting seronegative symmetric synovitis with pitting edema (RS3PE) with painful erythematous nodules
  1. Nicholas Kevin Laidler and
  2. Thomas Delaney
  1. Dermatology Department, Royal Perth Hospital, Perth, Western Australia, Australia
  1. Correspondence to Dr Nicholas Kevin Laidler; nicklaidler{at}


Remitting seronegative symmetric synovitis with pitting edema (RS3PE) is an uncommon syndrome characterised by acute onset severe synovitis of the radiocarpal and small joints of the hands, with associated pitting edema. Discussed here is the case of a 69-year-old man who presented to the emergency department of a tertiary hospital with acute bilateral hand swelling. This was on a background of a recent diagnosis of metastatic adenocarcinoma of the caecum and subsequent hemicolectomy. There was a history of general malaise, fever and lethargy for 5 days prior to the swelling of the hands. On examination, the upper limbs were swollen to the elbow bilaterally. Painful erythematous nodules were noted on the dorsal and palmar aspects of the hands and violaceous periungual discolouration was observed on the right fourth and fifth fingers. Prednisolone was commenced resulting in a dramatic resolution of the articular and cutaneous manifestations within 3 weeks.

  • dermatology
  • immunology
  • musculoskeletal syndromes
  • colon cancer

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  • Contributors NKL performed planning and writing of manuscript and images/figures. TD did identification of case, guidance, supervision and editing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.