title: Felty's syndrome as an initial presentation of rheumatoid arthritis: a case report.
abstract: BACKGROUND
  Felty's syndrome is an uncommon but severe extra-articular manifestation of rheumatoid arthritis. Felty's syndrome is characterized by the triad of rheumatoid arthritis, neutropenia, and splenomegaly. The lifetime risk of Felty's syndrome for a rheumatoid arthritis patient is less than 1% and there are only few case reports of Felty's syndrome with neutropenia preceded clinical evidence of arthritis. We present a case which is atypical presentation of Felty's syndrome without arthritis.
  
  
  METHODS
  We present a case of 31-year-old man who presented with fever and skin infection, found to have neutropenia. The work up showed splenomegaly and other evidences support Felty's syndrome diagnosis without arthritis presentation.
  
  
  CONCLUSIONS
  Patients with unexplained, continuous neutropenia without arthritis but with high level of rheumatoid factor and positive antibodies to cyclic citrullinated peptides should be suspected of developing Felty's syndrome as an initial presentation of rheumatoid arthritis.
authors: Department of Internal Medicine, James J Peters Veterans Affairs Medical Center, Mount Sinai School of Medicine Program, 130 W Kingsbridge Road, Bronx, NY 10468, New York, USA. Disaya.Chavalitdhamr@nbhn.net
authors: Disaya
authors: D
authors: Chavalitdhamrong
authors: Ana
authors: A
authors: Molovic-Kokovic
authors: Andrey
authors: A
authors: Iliev