A 68-year-old woman with seropositive rheumatoid arthritis presents with splenomegaly and a total leukocyte count of 2,100 per microlitre with neutrophil count 600 per microlitre. Bone marrow shows granulocytic hyperplasia. What is the most likely diagnosis?
- A T-cell large granular lymphocyte leukaemia
- B Systemic lupus erythematosus with haemophagocytosis
- C Felty syndrome ✓
- D Methotrexate-induced marrow suppression
Correct answer: C. Felty syndrome
Explanation
Felty syndrome is the triad of long-standing seropositive rheumatoid arthritis, splenomegaly, and neutropenia. The marrow typically shows hyperplasia of myeloid precursors because peripheral destruction and sequestration drive the cytopenia. T-cell LGL leukaemia mimics Felty and must be considered, but the question anchors on classic RA-associated features, and Indian exam convention treats Felty as the expected answer for this vignette. Methotrexate toxicity would show a hypocellular marrow.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.