A 60-year-old seropositive man with rheumatoid arthritis presents with splenomegaly and a total leucocyte count of 1800/mm3 with neutrophil predominance. Which complication is he at greatest risk of?
- A Recurrent bacterial infections ✓
- B Acute leukaemia transformation within months
- C Portal vein thrombosis
- D Massive upper gastrointestinal haemorrhage
Correct answer: A. Recurrent bacterial infections
Explanation
Felty syndrome comprises seropositive rheumatoid arthritis, splenomegaly, and neutropenia. The functional defect includes impaired neutrophil maturation and peripheral destruction driven by large granular lymphocyte expansion, so recurrent sinopulmonary and skin infections with Staphylococcus and Streptococcus are the main risk. Leukaemic transformation is not typical, although LGL leukaemia sits on the same spectrum, which makes distractor B plausible but wrong.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.