Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) as the presenting manifestation of colorectal cancer: A case report

Abstract

Introduction: Remitting Seronegative Symmetrical Synovitis with Pitting Edema (RS3PE) is a rare syndrome which was first reported by McCarty et al. in 1985. The association between RS3PE and both benign tumors and cancers has been reported in the literature. Case Presentation: We hereby report a case of RS3PE associated with an early-stage colorectal cancer. A 67-year-old male patient not known to have any medical illness presented to the rheumatology clinic complaining of bilateral joint pain in both ankles for 5 weeks associated with symmetrical feet edema. Laboratory findings showed negative rheumatoid factor (RF), anti-nuclear antibody (ANA), and anti-cyclic citrullinated peptide (anti-CCP). Inflammatory markers (C-reactive protein and erythrocyte sedimentation rate) were high. Ultrasound showed grade II synovitis in both ankles without erosions. The symptoms rapidly resolved with short-term low-dose corticosteroid. Fecal occult blood was requested, and it returned positive. Colonoscopy was done and showed polyploid lesions in transverse colon. The histopathological analysis revealed adenocarcinoma of the large bowel. Conclusion: In conclusion, RS3PE patients should be screened for concomitant malignancy in order to intervene immediately and treat cancer at an early and curable stage. Further studies on screening methods of malignancy in such patients are essential and critical to prevent the devastating complications.