A 62-year-old woman with seropositive erosive rheumatoid arthritis presents with fatigue and recurrent gum infections. Examination shows splenomegaly. Total leucocyte count is 2,100/mm3 with absolute neutrophil count of 550/mm3. What is the most likely diagnosis?

• A Still disease
• B T-cell large granular lymphocyte leukaemia
• C Adult-onset Stills-associated macrophage activation syndrome
• D Felty syndrome ✓

Explanation

The classic triad of Felty syndrome is long-standing seropositive rheumatoid arthritis, splenomegaly and neutropenia, often with recurrent infections and skin pigmentation. It typically appears late in the course of RA and reflects extra-articular systemic disease. T-cell large granular lymphocyte leukaemia is the closest distractor because it also causes neutropenia in RA, but it is a clonal expansion rather than the classic hypersplenic triad described here.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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