Diagnosis of Felty's syndrome, distinguished from hematological neoplasm: A case report

Abstract

Felty's syndrome (FS) is characterized by the three conditions of rheumatoid arthritis (RA), neutropenia and splenomegaly, and occurs in few cases of longstanding erosive RA. Discriminating between rare occurrences of autoimmune diseases and malignancies is crucial. The present study describes the case of a 17-year-old female with a two-year history of RA, presenting with an irregular fever, hepatosplenomegaly and enlarged lymph nodes. The antinuclear antibody titer was 1:320, while antibody results for anti-dsDNA, anti-Sm and rheumatoid factor were negative. The clinical presentation was similar to that of lymphoma. However, the fluorodeoxyglucose-positron emission tomography and biopsy examinations of the liver and cervical lymph node did not support the diagnosis of lymphoma. According to the laboratory results and clinical symptoms, the differential diagnosis indicated FS, and immunosuppressive agents were administered. Two weeks later, the patient no longer had a fever, and the transaminase levels were normal, associated with shrinkage of the liver and spleen.

Keywords: Felty’s syndrome; diagnosis; treatment.

Figure 1

Joint X-rays of (A) left and (B) right wrists.

Figure 2

Abdominal computed tomography (CT) scan of the patient with Felty’s syndrome (FS).

Figure 3

Microscopic analysis of the right cervical lymph node. (A) Hematoxylin and eosin staining. (B–D) Immunohistochemical staining. Positive staining for (B) cluster of differentiation (CD)79α and (C) CD20 in interfollicular regions. (D) Positive staining for CD5 in the paracortical area. Magnification, ×100.

Figure 4

Pathological evaluation of liver tissue by H&E staining. (A) Magnification, ×100. (B) Magnification, ×200.