SHM Converge Scientific Abstract ePoster Gallery-Felty's Syndrome Presenting as Neutropenic Fever

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This case describes a 56-year-old woman with hypertension and type 2 diabetes who presented to the emergency department with fever and confusion. She was found to have severe neutropenia, anemia, thrombocytopenia, and splenomegaly. Initial evaluation for infection and other common causes of neutropenic fever was negative, and prior bone marrow biopsies had shown no malignancy.<br /><br />Because of the combination of neutropenia and splenomegaly, rheumatologic testing was pursued. Results were strongly suggestive of rheumatoid arthritis, with elevated rheumatoid factor, anti-CCP antibodies, positive ANA, and low complement. CT imaging confirmed marked splenomegaly, and flow cytometry showed an atypical T-cell population, raising concern for Felty’s syndrome versus large granular lymphocytic leukemia. Further oncology evaluation, including repeat bone marrow biopsy and myelodysplastic syndrome testing, did not reveal cancer or another hematologic malignancy.<br /><br />The patient’s fever and confusion improved with antibiotics and supportive care, and her neutrophil count recovered after G-CSF. She was discharged on prednisone and methotrexate but was readmitted one month later with recurrent neutropenic fever. She ultimately underwent splenectomy, after which her white blood cell counts improved over the following months and she had no further episodes of neutropenia.<br /><br />Felty’s syndrome is classically defined by the triad of neutropenia, splenomegaly, and rheumatoid arthritis, usually occurring late in the course of long-standing RA. Neutropenia may be caused by immune mechanisms, including possible anti–G-CSF antibodies, and by splenic sequestration. Because large granular lymphocytic leukemia can present similarly, evaluation should include flow cytometry and bone marrow studies. Treatment typically begins with disease-modifying antirheumatic drugs, with splenectomy reserved for refractory cases. This case highlights the importance of considering Felty’s syndrome in patients with neutropenic fever, especially when splenomegaly and serologic evidence of rheumatoid arthritis are present.

Asset Subtitle

Victor E. Serrano Santiago

Meta Tag

Author List Victor E. Serrano Santiago, Zack J. Morgan

Category Clinical Vignettes

Concept Felty syndrome

Concept Neutropenia

Concept Splenomegaly

Concept Rheumatoid Arthritis

Concept Neutropenic Fever

Distinguished Non-Finalist

Presenter Organization Methodist Dallas Medical Center

Presenting Author Victor E. Serrano Santiago

Track Adult

Keywords

Felty syndrome

neutropenic fever

splenomegaly

rheumatoid arthritis

severe neutropenia

anti-CCP antibodies

rheumatoid factor

large granular lymphocytic leukemia

splenectomy

methotrexate

Felty syndrome

Neutropenia

Splenomegaly

Rheumatoid Arthritis

Neutropenic Fever