Abstract
IntroductionFelty's syndrome is an uncommon but severe extra-articular manifestation of rheumatoid arthtitis. Felty's syndrome is characterized by the triad of rheumatoid arthtitis, neutropenia, and splenomegaly. The lifetime risk of Felty's syndrome for a rheumatoid arthtitis patient is less than 1% and there are only few case reports of Felty's syndrome with neutropenia preceded clinical evidence of arthritis. We present a case which is atypical presentation of Felty's syndrome without arthritis.Case presentationWe present a case of 31-year-old man who presented with fever and skin infection, found to have neutropenia. The work up showed splenomegaly and other evidences support Felty's syndrome diagnosis without arthritis presentation.ConclusionPatients with unexplained, continuous neutropenia without arthristis but with high level of rheumatoid factor and positive antibodies to cyclic citrullinated peptides should be suspected of developing Felty's syndrome as an initial presentation of rheumatoid arthtitis.
Highlights
Felty's syndrome is an uncommon but severe extra-articular manifestation of rheumatoid arthtitis
Patients with unexplained, continuous neutropenia without arthristis but with high level of rheumatoid factor and positive antibodies to cyclic citrullinated peptides should be suspected of developing Felty's syndrome as an initial presentation of rheumatoid arthtitis
31-year-old Caucasian male with no significant past medical history presented with fever of 102 F, chills and 4 centimeters painful redness induration at right inguinal region for 1 week
Summary
Continuous neutropenia without arthristis but with high level of rheumatoid factor and positive antibodies to cyclic citrullinated peptides should be suspected of developing Felty's syndrome as an initial presentation of rheumatoid arthtitis. 31-year-old Caucasian male with no significant past medical history presented with fever of 102 F, chills and 4 centimeters painful redness induration at right inguinal region for 1 week He denied chest pain, shortness of breath, palpitations, cough, headache, dizziness, nausea, vomiting, abdominal pain, bowel or urinary symptoms, weight or appetite changes. Combination of RF and anti-CCP has specificity of 99.5% for RA and highly predictive for development of erosions at 5 years of disease [8] This case is an atypical presentation of FS because the lack of severe long lasting course of erosive RA. Overall treatment was tolerated well, except for the development of mild fever, mild arthritis and transient thrombocytopenia which are known side effects of G-CSF treatment He currently remains on methotrexate with reasonable control of his symptoms
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