title: Sarcoidosis with high serum levels of vascular endothelial growth factor (VEGF), showing RS3PE-like symptoms in extremities.
abstract: We report a patient with sarcoidosis who showed edema in the distal portion of all extremities, particularly the legs, as seen in remitting seronegative symmetrical synovitis with pitting edema (RS3PE). Magnetic resonance imaging demonstrated diffuse abnormal intensity in subcutaneous tissues of both legs, and skin biopsy led to a diagnosis of sarcoidosis. Vascular endothelial growth factor (VEGF) showed a high serum level, which decreased soon after starting oral prednisolone, in parallel with an improvement in the limb edema. In this patient VEGF as well as infiltration by sarcoid granuloma in the skin might have played an important role in the pathogenesis of RS3PE-like symptoms in the extremities. When painful pitting edema is seen predominantly in the distal portion of all extremities, sarcoidosis as well as RS3PE should be considered as a possible diagnosis.
authors.affiliation: Third Department of Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, 390-8621 Matsumoto, Japan. matsuda@hsp.md.shinshu-u.ac.jp
authors.forename: Masayuki
authors.initials: M
authors.lastname: Matsuda
authors.forename: Kumi
authors.initials: K
authors.lastname: Sakurai
authors.forename: Tomohisa
authors.initials: T
authors.lastname: Fushimi
authors.forename: Kanji
authors.initials: K
authors.lastname: Yamamoto
authors.forename: Shiho
authors.initials: S
authors.lastname: Rokuhara
authors.forename: Naritoshi
authors.initials: N
authors.lastname: Hosaka
authors.forename: Shu-ichi
authors.initials: S
authors.lastname: Ikeda
mesh_terms: D004487:Edema / Q000188:drug therapy / Q000276:immunology*; D005121:Extremities; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008875:Middle Aged; D011239:Prednisolone / Q000627:therapeutic use; D012507:Sarcoidosis / Q000097:blood / Q000150:complications / Q000188:drug therapy / Q000276:immunology*; D013585:Synovitis / Q000188:drug therapy / Q000276:immunology*; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000097:blood / Q000276:immunology*
chemical_list: D005938:Glucocorticoids; D042461:Vascular Endothelial Growth Factor A; D011239:Prednisolone