Journal
CLINICAL RHEUMATOLOGY
Volume 23, Issue 3, Pages 246-248Publisher
SPRINGER-VERLAG
DOI: 10.1007/s10067-003-0840-0
Keywords
angiotensin converting enzyme; bilateral hilar lymphadenopathy; prednisolone; remitting seronegative symmetrical synovitis with pitting edema; sarcoidosis; vascular endothelial growth factor
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We report a patient with sarcoidosis who showed edema in the distal portion of all extremities, particularly the legs, as seen in remitting seronegative symmetrical synovitis with pitting edema (RS3PE). Magnetic resonance imaging demonstrated diffuse abnormal intensity in subcutaneous tissues of both legs, and skin biopsy led to a diagnosis of sarcoidosis. Vascular endothelial growth factor (VEGF) showed a high serum level, which decreased soon after starting oral prednisolone, in parallel with an improvement in the limb edema. In this patient VEGF as well as infiltration by sarcoid granuloma in the skin might have played an important role in the pathogenesis of RS3PE-like symptoms in the extremities. When painful pitting edema is seen predominantly in the distal portion of all extremities, sarcoidosis as well as RS3PE should be considered as a possible diagnosis.
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