{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:14:28Z","timestamp":1753892068162,"version":"3.41.2"},"reference-count":10,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,4,4]],"date-time":"2025-04-04T00:00:00Z","timestamp":1743724800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pharmacol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Pleural effusion is a common disease in respiratory medicine, and rheumatoid arthritis (RA) is one of the causes of pleural effusion. Felty\u2019s syndrome is a special manifestation of RA. We report a case of Felty\u2019s syndrome with pleural effusion as the initial symptom and the subsequent diagnosis and treatment of the patient\u2019s secondary pyothorax.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case presentation<\/jats:title><jats:p>We report the case of a 78-year-old male who was admitted to the hospital after more than 1\u00a0year of discovered pleural effusion. After consultation with the Department of Rheumatology and Immunology, and considering the patient\u2019s symptoms of joint deformity and swelling pain, combined with decreased white blood cells, decreased platelets, and splenomegaly, the patient was diagnosed with RA Felty\u2019s syndrome. The patient was treated with iguratimod and methylprednisolone. Three months later, the patient was diagnosed as <jats:italic>Escherichia coli<\/jats:italic> empyema. The patient was treated with intravenous and sensitive anti-infection therapy combined with medical thoracoscopy, achieving good therapeutic effects.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Felty\u2019s syndrome is a rare manifestation of RA. Pleural effusion may be the initial manifestation of RA, and secondary infections are prone to occur during the treatment of RA and Felty\u2019s syndrome. The combination of sensitive antibiotics and medical thoracoscopy can effectively treat secondary pyothorax.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fphar.2025.1529621","type":"journal-article","created":{"date-parts":[[2025,4,4]],"date-time":"2025-04-04T05:15:05Z","timestamp":1743743705000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Case Report: A case of Felty\u2019s syndrome with initial presentation of pleural effusion and subsequent Escherichia coli pyothorax"],"prefix":"10.3389","volume":"16","author":[{"given":"Haifeng","family":"Yang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Weiqin","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yongfeng","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yibo","family":"Yang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yiliang","family":"Su","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,4,4]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"206","DOI":"10.1186\/1757-1626-2-206","article-title":"Felty's syndrome as an initial presentation of rheumatoid arthritis: a case report","volume":"2","author":"Chavalitdhamrong","year":"2009","journal-title":"Cases J."},{"key":"B2","doi-asserted-by":"publisher","first-page":"1479","DOI":"10.3390\/jpm13101479","article-title":"Cutaneous manifestations of rheumatoid arthritis: diagnosis and treatment","volume":"13","author":"Diaz","year":"2023","journal-title":"J. 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Dis."},{"key":"B9","doi-asserted-by":"publisher","first-page":"1","DOI":"10.7812\/TPP\/19.239","article-title":"Concomitant large loculated pleural and pericardial effusions in a patient with rheumatoid arthritis on methotrexate","volume":"24","author":"Whitfield","year":"2020","journal-title":"Perm. J."},{"key":"B10","doi-asserted-by":"publisher","first-page":"866068","DOI":"10.3389\/fmed.2022.866068","article-title":"Case report: acute myocarditis due to PD-L1 inhibitor durvalumab monotherapy in a patient with lung squamous cell carcinoma","volume":"9","author":"Zhou","year":"2022","journal-title":"Front. Med. 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