Introduction and Abstract Investigations and Images A CURIOUS CASE OF FELTY’S SYNDROME PREET SHAH JASLOK HOSPITAL AND RESEARCH CENTRE, MUMBAI Introduction and Abstract Felty’s Syndrome (FS) is an uncommon extra-articular manifestation of Rheumatoid Arthritis(RA). Its characterized by the triad of Rheumatoid Arthritis, Splenomegaly and Neutropenia. It usually presents in the elderly, who have had RA for a long duration. Arthritis develops first and precedes the development of neutropenia by many years. The lifetime risk of FS for a RA patient is <1%. Abstract: A 64 year old male, presented with complaints of dragging sensation in the left side of the abdomen, early satiety, anorexia and weight loss of 3 kgs, all since the past 2 months. He also had stiffness of the right hand since the past 1 month. No comorbidities. Clinically, he had swelling of all the Metacarpophalangeal (MCP) joints in right hand and had Splenomegaly (Hackett grade 2). Investigations and Images Positive findings on investigations: Hb was 13.2 gm/dl. Total WBC count of 1400/cumm, with neutrophil component being 45%. Platelets 120,000/cumm. USG Abdomen confirmed splenomegaly. In view of these findings, Bone Marrow aspiration and biopsy were done, which were normal. Simultaneously, to rule out common causes of arthritis, uric acid, RA factor, anti-CCP were sent, and X-ray of both hands was done. Uric Acid was normal. RA Factor was positive & anti-CCP titers were >500. X-Ray of both hands showed features suggestive of Rheumatoid Arthritis: B/L involvement of MCP and Proximal IP joints- sclerosis, joint space reduction, deformity, osteophytes. Conclusions This is an atypical presentation of FS because of the lack of long duration course of erosive RA. There is no specific diagnostic test for FS. It is a clinical diagnosis in RA with unexplained neutropenia and splenomegaly. Methotrexate was avoided in view of low counts. He was thus started on Hydroxychloroquine and NSAIDs for the joint involvement, with G-CSF for neutropenia.