Remitting seronegative symmetrical synovitis with pitting oedema following administration of the ChAdOx1-S/nCoV-19 Coronavirus vaccine
  • Syed Aun Muhammad
    Southend University Hospital, Mid and South Essex NHS Foundation Trust, Essex, UK
  • Fiona Coath
    Southend University Hospital, Mid and South Essex NHS Foundation Trust, Essex, UK
  • James Jegard
    Southend University Hospital, Mid and South Essex NHS Foundation Trust, Essex, UK

Keywords

RS3PE, ChAdOx1-S/nCoV-19 [recombinant] vaccine, coronavirus

Abstract

Introduction: We describe a case of remitting seronegative symmetrical synovitis with pitting oedema (RS3PE) syndrome following administration of the ChAdOx1-S/nCoV-19 [recombinant] vaccine, suggesting a possible causal link.
Case Description: A 72-year-old man presented to his general practitioner with swollen, oedematous hands and legs 2 weeks after receiving a coronavirus vaccine. He had raised inflammatory markers but remained systemically well. He was initially presumed to have cellulitis, but his symptoms persisted despite several courses of antibiotics. Deep vein thromboses, cardiac failure, renal failure and hypoalbuminaemia were ruled out. Upon Rheumatology review, he was diagnosed as having RS3PE syndrome with the Covid vaccine suspected of being an immunogenic trigger. Following initiation of steroid therapy, his symptoms improved dramatically, as is characteristic of RS3PE syndrome.
Discussion: The pathophysiology of RS3PE is unclear. It is known to have various triggers and associations including infections, certain vaccines and malignancy. This case highlights that a coronavirus vaccine (ChAdOx1-S/nCoV-19 [recombinant] vaccine) is also a possible trigger. Factors that make the diagnosis likely include an acute onset of symptoms including pitting oedema in a typical distribution, age above 50, and unremarkable autoimmune serology. Other learning points from this case include the importance of antibiotic stewardship and the need to explore non-infectious causes of illness when antibiotics do not improve symptoms.
Conclusion: The ChAdOx1-S/nCoV-19 [recombinant] vaccine is a possible trigger of RS3PE. However, the benefits of vaccines against coronavirus outweigh the risks in the majority of patients.

VIEW THE ENTIRE ARTICLE

References

  • Matsuda M, Sakurai K, Fushimi T, Yamamoto K, Rokuhara S, Hosaka N, et al. Sarcoidosis with high serum levels of vascular endothelial growth factor (VEGF), showing RS3PE-like symptoms in extremities. Clin Rheumatol 2004;23:246–248.
  • Tanaka T, Hagihara K, Shima Y, Narazaki M, Ogata A, Kawase I, et al. Treatment of a patient with remitting seronegative, symmetrical synovitis with pitting oedema with a humanized anti-interleukin-6 receptor antibody, tocilizumab. Rheumatology 2009;49:824–826.
  • Lakhmalla M, Dahiya D, Kichloo A, Fatima T, Edigin E, Wani F. Remitting seronegative symmetrical synovitis with pitting edema: a review. J Investig Med 2020;69:86–90.
  • Nicolás-Sánchez F, Rozadilla Sacanell J, Gort Oromí A, Torres Cortada G, Soler Rosell T, Sarrat-Nuevo R, et al. RS3PE asociado a tuberculosis. An Med Interna (Madrid) 2007;24:494–496.
  • Lakhmalla M, Dahiya D, Kichloo A, Fatima T, Edigin E, Wani F. Remitting seronegative symmetrical synovitis with pitting edema: a review. J Invest Med 2020;69:86–90.
  • Phoenix G, Das S, Joshi M. Diagnosis and management of cellulitis. BMJ 2012;345:e4955.
  • Kyotani M, Kenzaka T, Nishio R, Akita H. RS3PE syndrome developing during the course of probable toxic shock syndrome: a case report. BMC Infect Dis 2018;18:174.
  • Parperis K, Constantinou M. Remitting seronegative symmetrical synovitis with pitting oedema following BNT162b2 mRNA COVID-19 vaccination. BMJ Case Rep 2021;14:e244479.
  • Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 1981;30:239–245.1.
  • Views: 367
    HTML downloads: 71
    PDF downloads: 322


    Published: 2023-06-07
    Issue: 2023: Vol 10 No 6 (view)


    How to cite:
    1.
    Muhammad SA, Coath F, Jegard J. Remitting seronegative symmetrical synovitis with pitting oedema following administration of the ChAdOx1-S/nCoV-19 Coronavirus vaccine. EJCRIM 2023;10 doi:10.12890/2023_003742.