Diagnosis of Felty’s syndrome, distinguished from hematological neoplasm: A case report

Abstract

Felty’s syndrome (FS) is characterized by the three conditions of rheumatoid arthritis (RA), neutropenia and splenomegaly, and occurs in few cases of longstanding erosive RA. Discriminating between rare occurrences of autoimmune diseases and malignancies is crucial. The present study describes the case of a 17-year-old female with a two-year history of RA, presenting with an irregular fever, hepatosplenomegaly and enlarged lymph nodes. The antinuclear antibody titer was 1:320, while antibody results for anti-dsDNA, anti-Sm and rheumatoid factor were negative. The clinical presentation was similar to that of lymphoma. However, the fluorodeoxyglucose-positron emission tomography and biopsy examinations of the liver and cervical lymph node did not support the diagnosis of lymphoma. According to the laboratory results and clinical symptoms, the differential diagnosis indicated FS, and immunosuppressive agents were administered. Two weeks later, the patient no longer had a fever, and the transaminase levels were normal, associated with shrinkage of the liver and spleen.

Overlooked hematological markers of disease activity in rheumatoid arthritis

“…NLR has also been used as an indicator of the prognosis or mortality of various types of patients. In the present study, the mean NLR values of RA patients were found to be in line with the cut‐off values of Xiao et al . However, higher NLR values (3.92 ± 0.31) were evident in patients with higher‐level disease activity.…”

Phenotypic variability in a child with Felty’s syndrome: a case report

“…Current data show that 1-3% of RA patients are complicated with FS, with an estimated prevalence of 10 per 100,000 populations [12]. FS is rarely seen in patients with JIA, with only five cases having been reported throughout the world [4][5][6][7][8]. Table 2 provides a comparison of these five patients with our patient (patient 6).…”

“…To date, FS without arthritis has not been reported in children. Splenomegaly is not always present in adult FS [8], but it occurs in all children with FS. Neutropenia is the most common and important feature of FS.…”

“…A few case studies for children with FS have been published in English, but no Chinese studies were found. We performed a literature review and identified 5 children with FS [4][5][6][7][8]. Table 2 shows the major features of these cases.…”

“…The complete triad is not an absolute requirement, but persistent neutropenia with an absolute neutrophil count (ANC) less than 1500-2000/mm 3 is generally regarded as necessary for establishing the diagnosis in adult [3]. FS affects 1-3% of patients with RA, but it is rarely seen in patients with juvenile idiopathic arthritis (JIA), with only a few cases having been reported throughout the world [4][5][6][7][8]. The active extra-joint clinical features can be misleading in FS, and certain pediatrician focus on severe extra-articular disease and neutropenia, which suggests infectious diseases.…”