Impact of low-dose prednisolone on refractory pitting edema manifesting remitting seronegative symmetrical synovitis with pitting edema syndrome.

We encountered an elderly male patient who after cardiac surgery for mitral stenosis had refractory pitting edema in both legs involving painful leg joints after a 1-month history of waxing and waning arthralgia. His family doctor had prescribed a combination of diuretics, 40 mg furosemide and 25 mg spironolactone; however, pitting edema in his lower legs persisted. He was diagnosed with worsening of congestive heart failure because of a previous cardiac surgery and was transferred to our hospital. On admission, we closely observed the patient's condition and noticed that his body temperature increased to 38.0 °C every evening. Furthermore, his ankle joints felt feverish and were swollen. Therefore, we suspected polyarthritis as an etiology, although we initially suspected rheumatoid arthritis (RA). Antibody testing did not support RA diagnosis; therefore we concluded the association of remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome with his condition. After daily treatment with 15 mg prednisolone, the refractory edema symptom dramatically improved. The concept of RS3PE syndrome could explain such as an impressive clinical course. <Learning objective: Physicians encounter patients with pitting edema of unknown etiology in daily clinical practice. In particular, cardiologists usually tend to prescribe diuretics for patients with pitting edema in their legs. Cardiologists should consider RS3PE syndrome as a differential diagnosis, for patients with localized pitting edema in their extremities. This report cautions regarding arbitrarily prescribing diuretics for localized pitting edema.>.