A 52-year-old woman with long-standing rheumatoid arthritis is found to have neutropenia (ANC 0.9 × 10⁹/L) and splenomegaly. She has no fever. Which condition should be suspected?
- A Reactive hemophagocytic lymphohistiocytosis
- B Methotrexate-induced bone marrow suppression
- C Felty's syndrome ✓
- D T-cell large granular lymphocyte leukemia
Correct answer: C. Felty's syndrome
Explanation
Felty's syndrome is a triad of seropositive RA (usually severe, erosive, with high RF titer), splenomegaly, and neutropenia. It occurs in approximately 1% of RA patients with long-standing disease and carries a risk of recurrent infections due to neutropenia. The mechanism involves splenic sequestration and anti-neutrophil antibodies. T-LGL leukemia can also cause neutropenia and splenomegaly in RA but is a distinct clonal disorder. Methotrexate causes pancytopenia, not isolated neutropenia with splenomegaly.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.