A 52-year-old woman with rheumatoid arthritis presents with fatigue, recurrent infections, and leg ulcers. Examination reveals splenomegaly. Labs show hemoglobin 10.2 g/dL, WBC 1800/mm3, neutrophils 12%, platelets 140,000/mm3, and rheumatoid factor 1:512. What is the most likely diagnosis?
- A Felty syndrome ✓
- B Methotrexate-induced bone marrow suppression
- C Large granular lymphocytic leukemia
- D Secondary Sjogren syndrome with lymphoma
Correct answer: A. Felty syndrome
Explanation
Felty syndrome is the triad of seropositive rheumatoid arthritis, splenomegaly, and neutropenia. It typically occurs in long-standing seropositive RA. The neutropenia predisposes to recurrent infections. Methotrexate can cause cytopenias but would not explain splenomegaly in this classic triad. LGL leukemia can mimic Felty but is less common and requires flow cytometry for confirmation.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.