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| IMAGES IN MEDICINE |
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| Year : 2014 | Volume
: 60
| Issue : 2 | Page : 211 |
Pedal edema in a female of RS3PE
K Hattori1, T Konoshita2, S Wakahara3, I Miyamori2
1 Department of Internal Medicine, Katou Clinic, Fukui, Japan
2 Department of Internal Medicine, University of Fukui, Faculty of Medical Sciences, Eiheiji, Japan
3 Department of Internal Medicine, Nakamura Hospital, Echizen, Japan
| Date of Web Publication | 13-May-2014 |
Correspondence Address:
Dr. T Konoshita
Department of Internal Medicine, University of Fukui, Faculty of Medical Sciences, Eiheiji
Japan
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0022-3859.132369
How to cite this article:
Hattori K, Konoshita T, Wakahara S, Miyamori I. Pedal edema in a female of RS3PE. J Postgrad Med 2014;60:211 |
A 74-year-old woman developed bilateral pedal edema [Figure 1] in her course of treatment with levothyroxine for hypothyroidism. The dose was augmented but symptoms persisted. When she came to us, her pitting edema was limited to hands and feet. Laboratory data showed no sign of cardiac, hepatic or renal failure. Thyroid hormone levels were adequate (fT3 3.6 pg/ml, fT4 1.4 ng/dl, TSH 12.5 μU/ml). The, fT4 levels were in normal range and TSH levels were a little less than 10.0 microIU/ml as targeted. Her C-reactive protein (CRP) was augmented to 10.73 mg/dl and WBC count was 8,700/mm 3 . Her rheumatoid factor and anti-nuclear antibody including RNP, Sm and double-strand DNA were all negative. We thus suspected on remitting seronegative symmetrical synovitis with pitting edema (RS3PE). | Figure 1: A 74-year-old woman was referred to us because of severe bilateral pedal edema
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RS3PE was originally advocated by McCarty [1] and recently re-characterized. [2] We administered 10 mg of prednisolone and within a fortnight her edema disappeared [Figure 2] and CRP returned to normal (0.68 mg/dl). | Figure 2: Two weeks after 10 mg of prednisolone, the bilateral pedal edema was completely disappeared
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| :: References | |  |
| 1. | McCarty DJ, O'Duffy JD, Pearson L, Hunter JB. Remitting seronegative symmetrical synovitis with pitting edema. RS3PE syndrome. JAMA 1985;254:2763-7. 
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| 2. | Kimura M, Tokuda Y, Oshiawa H, Yoshida K, Utsunomiya M, Kobayashi T, et al. Clinical characteristics of patients with remitting seronegative symmetrical synovitis with pitting edema compared to patients with pure polymyalgia rheumatica. J Rheumatol 2012;39:148-53.
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[Figure 1], [Figure 2]
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