{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T16:03:26Z","timestamp":1782921806231,"version":"3.54.5"},"reference-count":14,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,5,27]],"date-time":"2021-05-27T00:00:00Z","timestamp":1622073600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,5,27]],"date-time":"2021-05-27T00:00:00Z","timestamp":1622073600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Med Case Reports"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Felty syndrome is a rare manifestation of chronic rheumatoid arthritis in which patients develop extraarticular features of hepatosplenomegaly and neutropenia. The typical presentation of Felty syndrome is in Caucasians, females, and patients with long-standing rheumatoid arthritis of 10 or more years. This case report presents a patient with an early-onset and atypical demographic for Felty syndrome.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>Our patient is a 28-year-old African American woman with past medical history of rheumatoid arthritis diagnosed in 2017, asthma, pneumonia, anemia, and mild intellectual disability who was admitted to inpatient care with fever, chills, and right ear pain for 7\u00a0days. The patient\u2019s mother, also her caregiver, brought the patient to the hospital after symptoms of fever and ear pain failed to improve. Our patient was diagnosed with sepsis secondary to pneumonia and urinary tract infection. She had been admitted twice in the past year, both times with a diagnosis of pneumonia. During this visit in September 2019, it was discovered that the patient had leukopenia and neutropenia. Bone marrow biopsy revealed increased immature mononuclear cells with left shift and rare mature neutrophils. During the hospital course, the patient was provisionally diagnosed with Felty syndrome and treated with adalimumab and hydroxychloroquine for her rheumatoid arthritis. Her sepsis secondary to pneumonia and urinary tract infection was treated with ceftriaxone and doxycycline, which was later switched to cefepime because of positive blood and urine cultures for <jats:italic>Pseudomonas aeruginosa<\/jats:italic>. She was discharged with stable vital signs and is continuing to control her rheumatoid arthritis with adalimumab.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>This case report details the clinical course of sepsis secondary to pneumonia and urinary tract infection in the setting of Felty syndrome. Our patient does not fit the conventional profile for presentation given her race, age, and the length of time following diagnosis of rheumatoid arthritis.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13256-021-02802-9","type":"journal-article","created":{"date-parts":[[2021,5,26]],"date-time":"2021-05-26T23:08:57Z","timestamp":1622070537000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Felty syndrome: a case report"],"prefix":"10.1186","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5170-859X","authenticated-orcid":false,"given":"Anupam","family":"Gupta","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aryan","family":"Abrahimi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aesha","family":"Patel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,5,27]]},"reference":[{"issue":"1","key":"2802_CR1","doi-asserted-by":"publisher","first-page":"129","DOI":"10.2174\/1874312901408010129","volume":"8","author":"MB Owlia","year":"2014","unstructured":"Owlia MB, Newman K, Akhtari M. Felty\u2019s syndrome, insights and updates. TORJ. 2014;8(1):129\u201336.","journal-title":"TORJ"},{"issue":"3","key":"2802_CR2","doi-asserted-by":"publisher","first-page":"713","DOI":"10.3892\/ol.2013.1779","volume":"7","author":"R-Z Xiao","year":"2014","unstructured":"Xiao R-Z, Xiong M-J, Long Z-J, Fan R-F, Lin D-J. Diagnosis of Felty\u2019s syndrome, distinguished from hematological neoplasm: a case report. Oncol Lett. 2014;7(3):713\u20136.","journal-title":"Oncol Lett"},{"issue":"6","key":"2802_CR3","doi-asserted-by":"publisher","first-page":"500","DOI":"10.1136\/ard.36.6.500","volume":"36","author":"CW Sienknecht","year":"1977","unstructured":"Sienknecht CW, Urowitz MB, Pruzanski W, Stein HB. Felty\u2019s syndrome. Clinical and serological analysis of 34 cases. Ann Rheum Dis. 1977;36(6):500\u20137.","journal-title":"Ann Rheum Dis"},{"key":"2802_CR4","unstructured":"Patel R, Akhondi H. Felty syndrome. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2020. Updated 10 Jan 2020."},{"issue":"6","key":"2802_CR5","doi-asserted-by":"publisher","first-page":"R1386","DOI":"10.1186\/ar1837","volume":"7","author":"C Turesson","year":"2005","unstructured":"Turesson C, Schaid DJ, Weyand CM, et\u00a0al. The impact of HLA-DRB1 genes on extra-articular disease manifestations in rheumatoid arthritis. Arthritis Res Ther. 2005;7(6):R1386.","journal-title":"Arthritis Res Ther"},{"key":"2802_CR6","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1002\/art.1780210304","volume":"21","author":"M Andreis","year":"1978","unstructured":"Andreis M, Hurd ER, Lospalluto J, Ziff M. Comparison of the presence of immune complexes in Felty\u2019s syndrome and rheumatoid arthritis. Arthritis Rheum. 1978;21:310\u20135.","journal-title":"Arthritis Rheum"},{"issue":"4","key":"2802_CR7","doi-asserted-by":"publisher","first-page":"393","DOI":"10.1093\/rheumatology\/39.4.393","volume":"39","author":"G Coakley","year":"2000","unstructured":"Coakley G. Major histocompatibility complex haplotypic associations in Felty\u2019s syndrome and large granular lymphocyte syndrome are secondary to allelic association with HLA-DRB1 *0401. Rheumatology. 2000;39(4):393\u20138.","journal-title":"Rheumatology"},{"issue":"1","key":"2802_CR8","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1016\/0002-9343(82)90921-4","volume":"73","author":"C Thorne","year":"1982","unstructured":"Thorne C, Urowitz M, Wanless I, Roberts E, Blendis L. Liver disease in Felty\u2019s syndrome. Am J Med. 1982;73(1):35\u201340.","journal-title":"Am J Med"},{"issue":"1","key":"2802_CR9","doi-asserted-by":"publisher","first-page":"206","DOI":"10.1186\/1757-1626-2-206","volume":"2","author":"D Chavalitdhamrong","year":"2009","unstructured":"Chavalitdhamrong D, Molovic-Kokovic A, Iliev A. Felty\u2019s syndrome as an initial presentation of rheumatoid arthritis: a case report. Cases J. 2009;2(1):206.","journal-title":"Cases J"},{"issue":"3","key":"2802_CR10","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1002\/art.1780230323","volume":"23","author":"RB Lewis","year":"1980","unstructured":"Lewis RB. Felty\u2019s syndrome in blacks. Arthritis Rheum. 1980;23(3):377\u20138.","journal-title":"Arthritis Rheum"},{"issue":"9","key":"2802_CR11","doi-asserted-by":"publisher","first-page":"999","DOI":"10.1002\/art.1780220908","volume":"22","author":"TE Termini","year":"1979","unstructured":"Termini TE, Biundo JJ, Ziff M. The rarity of Felty\u2019s syndrome in blacks. Arthritis Rheum. 1979;22(9):999\u20131005.","journal-title":"Arthritis Rheum"},{"issue":"2","key":"2802_CR12","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1002\/anr.1780320212","volume":"32","author":"JJ Fiechtner","year":"1989","unstructured":"Fiechtner JJ, Miller DR, Starkebaum G. Reversal of neutropenia with methotrexate treatment in patients with Felty\u2019s syndrome. Correlation of response with neutrophil-reactive IgG. Arthritis Care Res. 1989;32(2):194\u2013201.","journal-title":"Arthritis Care Res"},{"issue":"3","key":"2802_CR13","doi-asserted-by":"publisher","first-page":"120","DOI":"10.5152\/eurjrheumatol.2014.026","volume":"1","author":"A Yazici","year":"2014","unstructured":"Yazici A, Ucar A, Mehtap O, Orge Gonullu E, Tamer A. Presentation of three cases followed up with a diagnosis of Felty syndrome. Eur J Rheumatol. 2014;1(3):120\u20132.","journal-title":"Eur J Rheumatol"},{"issue":"3","key":"2802_CR14","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1016\/S0268-960X(96)90024-7","volume":"10","author":"EJ Rashba","year":"1996","unstructured":"Rashba EJ, Rowe JM, Packman CH. Treatment of the neutropenia of Felty syndrome. Blood Rev. 1996;10(3):177\u201384.","journal-title":"Blood Rev"}],"container-title":["Journal of Medical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13256-021-02802-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13256-021-02802-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13256-021-02802-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,5,26]],"date-time":"2021-05-26T23:48:31Z","timestamp":1622072911000},"score":1,"resource":{"primary":{"URL":"https:\/\/jmedicalcasereports.biomedcentral.com\/articles\/10.1186\/s13256-021-02802-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,27]]},"references-count":14,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["2802"],"URL":"https:\/\/doi.org\/10.1186\/s13256-021-02802-9","relation":{},"ISSN":["1752-1947"],"issn-type":[{"value":"1752-1947","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,27]]},"assertion":[{"value":"19 March 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 March 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 May 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.The need for ethical approval was waived by the local institutional review board (IRB).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent was obtained from the patient's mother for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"273"}}