Early Onset Felty Syndrome in Rheumatoid Arthritis: A Case Report

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Felty syndrome is a rare and serious complication of Rheumatoid Arthritis (RA), characterised by a triad of RA, splenomegaly (enlarged spleen), and neutropenia (low neutrophil count). RA, a systemic autoimmune inflammatory disease marked by synovitis, commonly occurs in the fifth or sixth decade of life and often affects patients with a history of RA exceeding ten years. It is more prevalent in the Caucasian population due to the underexpression of the Human Leukocyte Antigen (HLA)-DR4 gene in African Americans. Felty syndrome requires the presence of neutropenia, defined as an Absolute Neutrophil Count (ANC) below 2000 cells/mm³, alongside splenomegaly and long-standing RA. Hereby, the authors present a case report of a 44-year-old female with a three-year history of RA, who presented with ascites for nine months and was found to have portal hypertension. Her diagnosis of Felty syndrome was confirmed based on the triad of RA, neutropenia, and splenomegaly, highlighting the importance of early recognition and management to prevent severe complications such as infections and systemic issues like portal hypertension.