Presentation of three cases followed up with a diagnosis of Felty syndrome.

Abstract

An effective treatment strategy for Felty syndrome (FS) has not been developed so far. In this article, three cases with FS, who responded to different treatment modalities, have been presented. Case 1 was a 52-year-old male patient who initially received methotrexate, and then, he was switched to granulocyte colony-stimulating factor (G-CSF) and cyclosporine treatment when his neutropenia was further deteriorated. The patient needed monthly doses of G-CSF for nearly 6 months, and his steroid dose was increased. Afterwards, his neutropenia improved with cyclosporine, methotrexate, and hydroxychloroquine combination treatment. Case 2 was a 78-year-old female patient who was started on leflunomide, hydroxychloroquine, and 60 mg methylprednisolone. Case 3 was a 69-year-old female patient who was first treated with 32 mg methylprednisolone, G-CSF, and then with cyclosporine. Neutropenia of both patients improved, and their health status normalized at 2 months. Different treatment strategies have been tried for the management of FS; disease-modifying anti-rheumatic drugs have been used successfully alone or in combination with G-CSF. As seen in the last case, it should be kept in mind that patients can present predominantly with symptoms of infection or hematologic disorders.