Authors: Alma Almadani , Dania Sulaiman , Maysoun Kudsi , Ameen Suliman

Abstract

Background: Felty's syndrome is a rare condition affecting 1–3% of patients with rheumatoid arthritis. It typically arises after a prolonged course of RA. Although rheumatic fever and RA may share overlapping features, they are distinct entities; their co-occurrence in a patient is rare and considered coincidental.

Case presentation: A 27-year-old woman with childhood rheumatic fever and mitral stenosis presented with low-grade fever and inflammatory arthritis. Three years earlier, she had developed pancytopenia and hepatosplenomegaly, and she was recently diagnosed with seropositive rheumatoid arthritis. Her earlier cytopenias and organomegaly were retrospectively attributed to Felty’s syndrome, likely preceding RA onset. Treatment with corticosteroids and hydroxychloroquine led to significant improvement, and methotrexate was added for maintenance and relapse prevention.

Conclusion: Careful medical history and clinical examination, as well as thorough other investigations, should be performed to exclude other causes of neutropenia.

Keywords: Felty's Syndrome, rheumatoid arthritis, rheumatic fever, hepatosplenomegaly, pancytopenia.