Saeed Hasham, Ejikeme Chidinma, Tucktuck Marina, Jawed Qirat, Kessler William
Internal Medicine, Rutgers Health/Trinitas Regional Medical Center, Elizabeth, USA.
Internal Medicine, St. George's University Medical School, Elizabeth, USA.
Cureus. 2021 Aug 15;13(8):e17206. doi: 10.7759/cureus.17206. eCollection 2021 Aug.
Felty syndrome (FS), an uncommon manifestation seen in patients with rheumatoid arthritis (RA), usually presents as a triad of erosive arthritis, splenomegaly, and neutropenia. It is extremely rare for RA to present as FS or develop after initially presenting as neutropenia and splenomegaly. In this report, we describe a case of a 55-year-old woman who initially presented with fever and vaginal pain. Her sepsis workup revealed genital herpes in the setting of leukopenia, with an incidental finding of splenomegaly on imaging. The patient was managed with filgrastim and valacyclovir. Two weeks later, she presented again with pleuritic chest pain and worsening leukopenia. This led to an extensive workup by the hematology team to diagnose and confirm the diagnosis of FS. We also engage in a review of the existing literature of such cases and emphasize the importance of serological testing for RA in patients with leukopenia and splenomegaly, even in the absence of joint symptoms or prior diagnosis of RA. The management should be guided towards treating the infection, correcting the neutropenia, and treating the underlying chronic disease.
费尔蒂综合征（FS）是类风湿关节炎（RA）患者中一种不常见的表现，通常表现为侵蚀性关节炎、脾肿大和中性粒细胞减少三联征。类风湿关节炎以费尔蒂综合征形式出现或在最初表现为中性粒细胞减少和脾肿大后发展为费尔蒂综合征极为罕见。在本报告中，我们描述了一例55岁女性患者，她最初表现为发热和阴道疼痛。她的败血症检查显示在白细胞减少的情况下患有生殖器疱疹，影像学检查偶然发现脾肿大。患者接受了非格司亭和伐昔洛韦治疗。两周后，她再次出现胸膜炎性胸痛和白细胞减少加重。这促使血液学团队进行了广泛检查以诊断并确诊费尔蒂综合征。我们还对这类病例的现有文献进行了综述，并强调即使在没有关节症状或既往无类风湿关节炎诊断的白细胞减少和脾肿大患者中，进行类风湿关节炎血清学检测的重要性。治疗应针对治疗感染、纠正中性粒细胞减少以及治疗潜在的慢性疾病。
