Felty’s Syndrome with Nodular Regenerative Hyperplasia of Liver and Portal Hypertension

Felty’s syndrome is one of the rare extra articular manifestations of rheumatoid arthritis described as early as 1924 [1]. But it is rarely seen these days due to early initiation of treatment for rheumatoid arthritis. It comprises the classical triad of joint symptoms (RA) with neutropenia and splenomegaly. Usually it is found in patients with long standing rheumatoid arthritis with joint erosions, deformities and rheumatoid nodules. They usually have HLA DR4 positivity with high titers of rheumatoid factor [2]. But our patient had relatively short duration of disease with no erosions, deformities or rheumatoid nodules. Felty’s syndrome as the presenting manifestation of Rheumatoid arthritis has been rarely reported in literature [2]. Our patient though had joint symptoms previously, she presented only because of worsening of symptoms due to severe anemia. These patients can have commonly skin, soft tissue and upper and lower respiratory tract infections. Our patient had recurrent episodes of fever with soft tissue infections (Figure 1).