Transthoracic echocardiography (TTE) revealed a normal sized left ventricle (LVEDD: 44 mm) and left atrium. Right-sided chambers were normal and systolic functions of both sides of the heart were preserved (LVEF:60%). There was a thickened chordae tendineae

Syndrome of Remitting Seronegative Symmetrical Synovitis with Pitting oedema (RS3PE) is a rare condition which is easily missed because of lack of clinical vigilance and presence of other relatively common rheumatological conditions that mimic RS3PE. We discuss a case which presented with acute onset synovitis and pitting oedema of the extremities. The patient did not have any other systemic causes for pitting oedema. He had elevated inflammatory markers and negative rheumatoid factors. There was no radiological evidence of bony erosion. Ultrasound scan of hands showed evidence of extensor tenosynovitis. He had a significant response to low dose steroids. RS3PE may be associated with malignancy and it was excluded during our evaluation.