A 62-year-old woman with long-standing seropositive rheumatoid arthritis presents with recurrent bacterial infections, painful leg ulcers, and splenomegaly. Laboratory studies show a neutrophil count of 0.8 x 10^9/L. What is the most likely diagnosis?

• A Hypersplenism due to portal hypertension
• B Drug-induced neutropenia from methotrexate
• C Large granular lymphocytic leukemia
• D Felty syndrome ✓

Explanation

Felty syndrome is the triad of rheumatoid arthritis, splenomegaly, and neutropenia. It occurs in seropositive RA. Methotrexate can cause neutropenia, but the presence of splenomegaly and classic triad points to Felty syndrome. Large granular lymphocytic leukemia can mimic this but is rare. Hypersplenism alone does not explain the RA context.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.