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T-Cell Large Granular Lymphocyte Leukemia in a Patient With Rheumatoid Arthritis
Sara Naji Rad1, Behnam Rafiee2, Gagan Raju3
1Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Summary
Large granular lymphocyte leukemia (T-LGL) can present alongside rheumatoid arthritis (RA). This case highlights T-LGL in a patient with RA, suggesting a potential overlap in disease spectrum.
Area of Science:
- Hematology
- Immunology
- Rheumatology
Background:
- Large granular lymphocyte leukemia (LGL) is an indolent lymphoproliferative disorder.
- T-cell LGL (T-LGL) comprises 85% of LGL cases, originating from T-cell lineage.
- T-LGL frequently coexists with autoimmune disorders, particularly rheumatoid arthritis (RA).
Observation:
- Felty's syndrome (FS), characterized by splenomegaly, neutropenia, and arthritis, affects <1% of RA patients.
- 30-40% of FS patients exhibit circulating large granulated lymphocytes.
- A case of long-standing RA without Disease Modifying Anti-Rheumatic Drugs (DMARDs) treatment presented with constitutional symptoms, neutropenia, and splenomegaly.
Findings:
- The patient with RA was diagnosed with T-cell LGL leukemia.
- Clinical, therapeutic, and immunogenetic similarities suggest FS and T-LGL with RA may represent a single disease spectrum.
- T-LGL diagnosis was established in an RA patient presenting with constitutional symptoms, neutropenia, and splenomegaly.
Implications:
- The findings suggest a potential shared pathophysiology between T-LGL and RA, possibly encompassing Felty's syndrome.
- Recognizing T-LGL in RA patients with specific symptoms like neutropenia and splenomegaly is crucial for accurate diagnosis.
- Further research into the spectrum of T-LGL and RA could lead to improved diagnostic and therapeutic strategies.
