An 89-year-old male patient with no pathological history of interest consulted for anorexia of one and a half months' duration accompanied by oedema of the hands and feet. He reported some episodes of rectorrhagia. Physical examination only revealed oedema with fovea limited to the metacarpophalangeal and metatarsophalangeal joints. With the diagnosis of suspected RS3PE, therapy with prednisone 20 mg/24 hours was started, and the oedema disappeared completely after 5 days of treatment. Given that this syndrome can appear in association with other pathologies, the patient was studied.

In the complementary tests the haemoglobin was Hb 10.3 g/dL, with MCV 94.5 fl. The biochemistry, glucose, urea, creatinine, uric acid, total calcium, phosphate, cholesterol, HDL-cholesterol, LDL-cholesterol, total proteins, GPT, LDH, GGT, Na, K were normal. Cobalamins and folates were normal. Beta-2-microglobulin was normal. The proteinogram showed a monoclonal band to IgA lambda. C-reactive protein and ESR were normal. Interleukin 6 was normal. HIV serology was negative. Rheumatoid factor, antinuclear antibodies and anti-neutrophil cytoplasmic antibodies were negative. PSA was normal. HLA-B27 phenotype was positive. Bence-Jones proteinuria was negative. Colonoscopy was normal. X-rays of the hands and feet showed no erosive lesions. Thoracic CT in the posterior segment of the LSD showed a pulmonary infiltrate adopting a branched (tree inbud) and nodular morphology; in the LM there was also an infiltrate of branched, nodular morphology and a subsegmental condensation with air bronchogram; biapical pleuroparenchymal tracts with thin-walled cylindrical bronchiectasis in LII and thickening of lingula, and pleura. Abdominal CT scan urinary bladder with thickening of the bladder floor, multiple diverticula, prostatic hypertrophy. Bronchoscopy showed a trachea and left bronchial tree with chronic inflammatory signs, including diverticula and anthracosis plaques throughout the bronchial tree; at the level of the right bronchial tree, in the bronchus intermedius a few mm before reaching the LM entrance, mucous infiltration was observed and at the LM entrance there was a mass of necrotic and very friable appearance that totally obstructed the entrance; a bronchial biopsy was not performed due to bleeding. Cytological examination of the BAS revealed an acute inflammatory smear. The Löwestein culture of the BAS was positive for Mycobacterium tuberculosis.
The patient's progress showed that 5 days after starting corticosteroid treatment, the oedema of the hands and feet disappeared, and haemoglobin levels returned to normal one month later. Four months after starting prednisone, Mycobacterium tuberculosis was identified and isoniazid, rifampicin and pyrazinamide were prescribed, and corticosteroid treatment was suspended due to suspicion of Poncet's disease. Three months after starting the tuberculostatics and withdrawing the corticosteroids, the oedema in the hands and feet reappeared, so corticosteroid treatment was reintroduced.