CASE REPORT   

Gazzetta Medica Italiana - Archivio per le Scienze Mediche 2020 April;179(4):305-10

DOI: 10.23736/S0393-3660.19.04183-4

Copyright © 2019 EDIZIONI MINERVA MEDICA

lingua: Inglese

Three-years follow-up of a case of non-articular Felty Syndrome treated solely with corticosteroids

Verónica B. GUIOMAR ✉, Sofia TAVARES, Diana OLIVEIRA, Clara GOMES, Pedro RODRIGUES, Cristina CORREIA, Edite PEREIRA

Department of Internal Medicine, Hospital of São João, Porto, Portugal

A 54-year-old Caucasian male presented to the emergency department complaining of odynophagia, fever and malaise. Blood test showed pancytopenia with severe neutropenia (50 neutrophils/microliter), mild elevation of cholestasis enzymes and high C-reactive protein. Abdominal ultrasonography showed hepatosplenomegaly and signs of portal hypertension. He was a non-smoker with no alcohol or recreational drug use and without recent travels. He had a previous history of recurrent arthralgias with a positive title for rheumatoid factor but without criteria for Rheumatoid Arthritis. There were no clinical or radiological signs of joint destruction. After excluding other causes, a diagnosis of non-articular Felty Syndrome was presumed and the patient was started on glucocorticoids. Neutropenia resolved completely in 4 months, under a low maintenance dose of prednisolone (0.25mg/kg/day). The patient remains without articular manifestations on 3-years follow-up. We report an unusual case of non-articular Felty Syndrome as the first manifestation of Rheumatoid Arthritis. This is the first case report of a 3-years follow-up of a patient under a low dose of prednisolone that remained asymptomatic without therapy with a disease-modifying antirheumatic drug. There is only one case report describing successful use of prednisolone as monotherapy but follow-up is not available. This case showed that Felty Syndrome prognosis could be better than expected in some patients, mainly in those with short disease duration, without severe long-lasting erosive arthritis and less exposed to immunosuppression. This case also highlights the importance of an accurate differential diagnosis so as to recognise an uncommon presentation of Rheumatoid Arthritis.

KEY WORDS: Neutropenia; Splenomegaly; Arthritis, rheumatoid; Felty Syndrome; Adrenal cortex hormones