Remitting seronegative symmetrical synovitis with fitting edema following intravesical bacillus Calmette-Guerin instillation

Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) is a rare syndrome of undetermined etiology occurring in the elderly. We descr ibe the first ease of RS3PE in a HLA-B27 positive 65-year-old man following intravesical bacillus Calmette-Guerin (BCG) instillation for bladder carci noma. He developed symmetrical arthritis and synovitis involving wrists, kn ees, ankles, and metatarsophalangeal joints, with marked pitting edema of t he dorsa of both hands and feet, fever, and elevated acute phase reactants. Right knee effusion revealed nonspecific sterile inflammatory fluid. He re sponded dramatically to nonsteroidal antiinflammatory drugs. BCG instillati on may have triggered active symmetrical synovitis via local T cell activat ion and a T-helper-1 (Th-1)/Th-2 inflammatory profile.