A Case of Paraneoplastic Remitting Seronegative Symmetrical Synovitis with Pitting Edema Syndrome Improved by Chemotherapy

Abstract

The patient was a 69-year-old male who had started experiencing acute-onset pain in both shoulder joints and edema of both hands and feet. His symptoms progressively worsened within 1 month. Laboratory data indicated elevated CRP and erythrocyte sedimentation rate despite the normal range of antinuclear antibodies and rheumatoid factor and normal organ function. Furthermore, imaging data of the hand indicated synovitis without bone erosions. Meanwhile, chest CT revealed a lung tumor, leading to a diagnosis of primary lung adenocarcinoma with EGFR mutation (cT2aN3M0, stage IIIB). Based on these findings, he was diagnosed as suffering from paraneoplastic remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome. Thereafter, his symptoms disappeared as the tumor size was rapidly decreased by gefitinib therapy for lung adenocarcinoma. Currently, RS3PE syndrome can be classified as a vascular endothelial growth factor (VEGF)-associated disorder. Given that his symptoms improved by chemotherapy, the present case further supported the possible hypothesis that paraneoplastic RS3PE syndrome might be caused by tumor-induced VEGF. Therefore, the present case suggested that the symptoms of acute-onset joint pain accompanied by pitting edema in elderly patients should be considered suspicious for a malignant tumor, thereby warranting a detailed full-body examination.

Remitting Seronegative Symmetrical Synovitis with Pitting Oedema as the First Manifestation of an Adenocarcinoma of the Caecum

“…The absence of RS3PE3 relapse after surgical extraction of the tumour despite the suspension of corticotherapy suggests the tumour played a major role in the aetiopathogenesis of the syndrome. A similar response to surgical resection of the tumour or to chemotherapy has been reported in other cases [5,6] .…”

Паранеопластический Ревматоидоподобный Артрит При Раке Легкого

“…3). The RLA is closely associated with metastases growing into jaws (D=23.28, p<0.001) and pubic bone (D=11.04, p=0.001), absent in the control group (respectively χ 2 =21.50, p<0.001 According to the reference data, the RLA is more often observed with lung adenocarcinoma [17] and with bone metastases [18]; its course is naturally associated with C-reactive protein (CRP) and seronegativity by the rheumatoid factor (RF) [13], corresponding with the data obtained. The fact of interaction of RA and oncological pathology's effects is mostly attributed to the manifest similarity of immune system deregulation in both diseases [19][20][21].…”

“…Paraneoplastic syndrome (PNPS) is not immediately associated with a primary neoplasm and its metastases; however, it is generated by the complex inflammatory systemic and local distant alterations, often in the form of the rheumatic and tumor overlap [5,6].The PNPS attending LC manifests itself by rheumatoid-like arthritis (RLA) [7], reducing the survival rate of patients with this malignant tumor [8][9][10], while a successful LC treatment (surgery, radiation chemotherapy) may be followed by the RLA signs' disappearance [11,12]. By contrast to the "primary" rheumatoid arthritis (RA), the RLA mostly affects middle and large joints (for instance, glenohumeral one), has an acute or sub-acute onset and involves a periarticular swelling [13]. Overall, the remitting seronegative synovitis should be a warning against a tumor process in case of absent glucocorticoid treatment [14].…”

Malignant catatonia due to anti-NMDA-receptor encephalitis in a 15-year-old girl: case report and summary of current knowledge

“…Plain radiographs do not show erosive disease. Modalities like ultrasound and Magnetic Resonance Imaging (MRI) often shows tenosynovitis in extensor tendons [14].…”