Remitting seronegative symmetrical synovitis with pitting edema syndrome postsecond COVID-19 vaccination: a case report

Coronavirus disease 19 (COVID-19) has become the most serious public health crisis of our generation, and vaccines are effective in preventing its infection. Remitting seronegative symmetrical synovitis with pitting edema is an idiopathic rare benign syndrome, but it could be secondary to aautoimmune diseases. Here, the authors reported the first case of this syndrome’s development after COVID-19 vaccination. CASE PRESENTATION: A 52-year-old woman presented with hand edema, arthralgia, and morning stiffness, after receiving the second dose of m RNA COVID-19 vaccination. Examination revealed edema in the dorsum of both hands and symmetrical tenderness of the shoulders, elbows, wrists, knees, and ankles. Blood test results were normal except for elevated levels of C-reactive protein. The immune profile and the tuberculin test were also negative. A hand radiograph showed soft tissue edema. Ultrasonography of the extremities has shown tenosynovitis. Remitting seronegative symmetrical synovitis with pitting edema syndrome was diagnosed according to the diagnostic criteria. She was treated with 30 mg/day prednisolone, with a complete disappearance of edema and arthralgia after 10 days, and the C-reactive protein level was decreased. CLINICAL DISCUSSION: Vaccines are still the most effective and protective method against COVID-19 infection, but it may trigger an immunological response. Remitting seronegative symmetrical synovitis with pitting edema (or sometimes RS 3 PE) is a rare nonunderstood syndrome identified by symmetric polyarthritis, synovitis, acute pitting edema of hands and/or feet, and a negative serum rheumatoid factor, with an excellent prognosis to treatment with steroid. Usually occurred in the old aged population, young patients’ cases were mentioned. As the authors did not find any data about our subject, this is the first case of this syndrome development after the second dose of COVID-19 vaccination. CONCLUSION: The occurrence of acute symmetrical seronegative polysynovitis with extremities edema, in the elderly, should guide toward the diagnosis of this syndrome.