Unilateral RS3PE syndrome in a patient with hemiplegia

Remitting seronegative symmetrical synovitis with pitting oedema (RS3PE) syndrome is a rare condition characterised by symmetrical swelling of the hands and/or feet and pitting oedema. The symmetry of the symptoms, as indicated by the name, is a hallmark of RS3PE syndrome as well as most other forms of systemic, autoimmune disease. However, cases with only unilateral involvement of the non-paralytic side have reportedly been associated with various rheumatic disorders, particularly those involving hemiplegia. Clinical awareness of such conditions is poor. Herein, we describe a unique case of unilateral RS3PE syndrome in a patient with pre-existing hemiplegia. The findings of this report underscore the need for clinicians to recognise that RS3PE syndrome does not always present symmetrically in patients with a neurological deficit.