The authors describe the case of a 42 years-old female patient with rheumatoid arthritis WITH A 20 years OF FOLLOW-UP. The patient was using METHOTREXATE (20 mg/WEEK); she developed neutropenia and splenomegaly that persisted despite changing medication for cYclosporine A. She then developed oropharyngeal, skin and urinary tract infections. After excluding for hematological affections, she was diagnosed as presenting Felty's syndrome. She was started on antibiotics while receiving also granulocyte-macrophage colony stimulating factor, pulsed methylprednisolone, andleflunomide. Two moths after the initiation ofleflunomide, she was admitted to an emergency hospital unit with septic shock that resulted in her death in a few hours
Felty's syndrome; infection; splenomegaly; treatment; neutropenia
