Novel Development of Remitting Seronegative Symmetrical Synovitis with Pitting Edema (RS3PE) Syndrome due to Insulin Therapy.
METHODS
Male, 67 FINAL DIAGNOSIS: Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome Symptoms: Bilateral wrist swelling Medication: - Clinical Procedure: - Specialty: Rheumatology.


OBJECTIVE
Unusual or unexpected effect of treatment.


BACKGROUND
Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome is a rare clinical entity characterized by the sudden onset of inflammatory arthritis and marked pitting edema on upper and lower extremities. RS3PE is considered a rheumatic process distinct from rheumatoid arthritis, which may occasionally represent a paraneoplastic syndrome.


METHODS
Herein, we describe a rare case of RS3PE associated with insulin therapy in a patient with no evidence of underlying malignancy.


CONCLUSIONS
To the best of our knowledge, this is the first case report of RS3PE associated with insulin therapy. Physicians should look at the introduction of drugs as possible triggers for the development of RS3PE.
Department of Internal Medicine, Reading Health System, West Reading, PA, U.S.A.
Naba Raj
NR
Mainali
Department of Internal Medicine, Robert Wood Johnson University Hospital, New Brunswick, NJ, U.S.A.
Torrey R
TR
Schmidt
Department of Internal Medicine, Reading Health System, West Reading, PA, U.S.A. ; Jefferson Medical College, Philadelphia, PA, U.S.A.
Richard
R
Alweis
Department of Internal Medicine, Reading Health System, West Reading, PA, U.S.A. ; Jefferson Medical College, Philadelphia, PA, U.S.A.
David L
DL
George
Hydroxychloroquine; Insulin – therapeutic use; RS3PE; Steroid; Synovitis