Myelodysplastic syndrome precedes the onset of remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome.
Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome is characterized by symmetrical synovitis predominantly involving the wrists, and is associated with marked pitting edema of the dorsum of the hands. Although the etiology of RS3PE syndrome is still unknown, several putative associations with malignancies and hematological disorders have been reported. Myelodysplastic syndrome (MDS) is characterized by infective hematopoiesis with possible transformation to leukemia; however, an association between RS3PE syndrome and MDS has been rarely reported. Here, we describe a 67-year-old man with MDS with refractory anemia who developed RS3PE syndrome 3 months after the diagnosis of MDS. The patient presented with polyarthritis with pitting edema at the dorsum of the hands, the elevated serum levels of C-reactive protein and a proinflammatory cytokine, interleukin-6, and the elevated plasma levels of vascular endothelial growth factor (VEGF). VEGF has been shown to be involved in the pathogenesis of RS3PE syndrome. Treatment with low doses of corticosteroids resulted in the regression of polyarthritis and pitting edema of the dorsum of the hands, as well as a reduction in the elevated levels of plasma VEGF. Partial resolution of refractory anemia was also observed with steroid therapy. In summary, RS3PE syndrome developed shortly after MDS was identified in this patient. The sequence of clinical events suggests that MDS-mediated immunological abnormalities including inflammatory cytokine induction may be responsible for the association between MDS and RS3PE syndrome. Patients with RS3PE syndrome should be screened for hematological disorders that promote proinflammatory mediators.
Department of General Internal Medicine, Nagasaki Medical Center.
Takafumi
T
Matsunaga
Yasumori
Y
Izumi
Nozomi
N
Iwanaga
Chieko
C
Kawahara
Yoshika
Y
Shigemitsu
Shinichiro
S
Yoshida
Atsushi
A
Kawakami
Daisuke
D
Ogawa
Kiyoshi
K
Migita
D000368:Aged; D001707:Biopsy, Needle; D001853:Bone Marrow / Q000473:pathology; D002871:Chromosome Banding; D004487:Edema / Q000150:complications*; D006225:Hand / Q000000981:diagnostic imaging; D006801:Humans; D007621:Karyotyping; D008279:Magnetic Resonance Imaging; D008297:Male; D009190:Myelodysplastic Syndromes / Q000150:complications*; D011859:Radiography; D013577:Syndrome; D013585:Synovitis / Q000150:complications*