Felty Syndrome Presented With Candida albicans Lung Abscess Without Arthritis: A Case Report

TL;DR

A patient with newly diagnosed rheumatoid arthritis showed signs of Felty syndrome with a lung infection, highlighting the need for early suspicion of this condition.

Contribution

This case report highlights an unusual early presentation of Felty syndrome without active arthritis in a newly diagnosed rheumatoid arthritis patient.

Findings

Felty syndrome was diagnosed in a patient with newly diagnosed rheumatoid arthritis and no active arthritis.

Candida albicans lung abscess was identified as the presenting feature of Felty syndrome.

The patient's symptoms improved with antifungal treatment and corticosteroids.

Abstract

Felty syndrome (FS) is a late manifestation of severe active rheumatoid arthritis (RA). A high index of suspicion or FS is needed in patients who present with neutropaenia and splenomegaly with no initial or obvious identifiable cause. We present the case of a 52-year-old who presented with a one-week history of haemoptysis, fever, and night sweats. The patient was hypotensive, tachycardia, and febrile (38 °C). On examination, bilateral crackles and reduced air entry were identified on the right basal and middle zones. The patient was diagnosed with RA two years prior to this presentation and was not on a disease-modifying antirheumatic drug (DMARD). Haematology showed high inflammatory markers and pancytopenia. Chest X-ray showed a right upper lobe abscess. CT-thorax, abdomen, and pelvis confirmed lung abscesses and hepatosplenomegaly. Candida albicans was detected on the broncho-alveolar lavage. He responded well to antifungal medication and corticosteroids with normalisation of the pancytopenia and inflammatory markers and reduction of the spleen size. This case report details the unusual and early presentation of FS in a patient newly diagnosed with RA and who had no active arthritis. We wish to emphasize the importance of a high index of suspicion in patients with RA regardless of the length of their illness.

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