Successful Treatment of Perianal Ulcers in a Patient with Felty's Syndrome Using Granulocyte Colony Stimulating...

We report a case of Felty's syndrome in a 65-year-old woman with chronic nonhealing perianal ulcers caused by persistent granulocytopenia. She was successfully treated with low dose recombinant human granulocyte-colony stimulating factor (G-CSF) 300 mug twice weekly. G-CSF contributed to an increase in neutrophil counts and gradual healing of the ulcers. There was no evidence of exacerbation of the rheumatoid arthritis during the 3-month treatment period. Discontinuation of the G-CSF resulted in a return to the baseline neutropenic state without recurrence of ulceration. Intermittent use of G-CSF may be useful therapy for patients who have Felty's Syndrome and develop complications from their neutropenia. A literature review of treatment modalities for these complications suggests that G-CSF appears to be reliable and efficacious, with few reported adverse events in this group of patients.