Remitting Seronegative Symmetrical Synovitis with Pitting Edema (RS3PE) Associated with DPP-4 Inhibitor

An 80-year-old man, a former truck driver from the Dominican Republic, was admitted with 3 months of abrupt-onset bilateral pain and swelling of his hands and feet, fever, and malaise. His symptoms were causing increasing difficulty with his daily activities, evident by a decline in ambulation and ability to grip. Three weeks prior to symptom onset, due to a hemoglobin A1c of 14% accompanied by an unintentional 7-kg weight loss, his outpatient physician had started him on sitagliptin to better control his type 2 diabetes mellitus. In addition to diabetes, the patient had benign prostate hypertrophy, hypertension, and history of a mitral valve repair. He had been managed chronically with aspirin, atorvastatin, chlorthalidone, losartan, nifedipine, metformin, and gabapentin.