Lung cancer associated with remitting seronegative symmetrical synovitis with pitting edema-like features

Abstract

Background. Remitting seronegative symmetrical synovitis with pitting edema (RS3PE), a paraneoplastic syndrome, has rarely been reported to be associated with lung cancer. We report a case of a patient with RS3PE who recovered after resection of a lung tumor. Case. A 79-year-old man had pitting edema of the lower legs and dorsal areas of the feet since December 2009, and thereafter, swelling in his fingers and wrists, with heat and pain in his wrists and ankles gradually developed. An abnormal shadow was incidentally identified in the left middle lung field on a chest radiograph during a medical examination in April 2010, after which he was referred to our hospital for further evaluation. A chest computed tomography scan showed a 40 x 37 mm mass in the left lingular segment, which was identified as lung cancer by transbronchial biopsy. We made a diagnosis of RE3PE syndrome associated with primary lung cancer and performed a left upper lobectomy with lymph node dissection. During the postoperative course, his joint symptoms rapidly recovered, and 8 months after the operation, the patient was alive and well. Conclusion. In elderly patients with pitting edema associated with rapidly evolving synovitis, paraneoplastic arthritis should be considered. © 2011 The Japan Lung Cancer Society.