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Felty syndrome — SCE Rheumatology MCQ

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HardRheumatoid arthritisFelty syndromeSCE Rheumatology

A patient with longstanding seropositive RA has splenomegaly and neutrophils 0.6 ×10⁹/L. Blood film shows a modest LGL population, but flow cytometry is non-aberrant and repeated T-cell-receptor studies show no clone. What diagnosis is favoured?

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Correct answer: D — Felty syndrome after excluding drug toxicity, infection and other marrow disease

Explanation lettering: C = shown as B · B = shown as C · E = shown as D · D = shown as E

E is correct. Severe seropositive RA, splenomegaly and neutropenia with no persistent clonal T-cell population favour Felty syndrome after other causes are excluded. A remains the close mimic but requires a convincing clonal lymphoproliferation. B is a lung-toxicity syndrome. C does not explain this triad. D is pneumoconiosis with rheumatoid nodules, not a neutropenic syndrome.

Reference: Felty syndrome review: distinction from T-cell large-granular-lymphocyte leukaemia: https://pmc.ncbi.nlm.nih.gov/articles/PMC10619942/