Portal hypertension in Felty's syndrome

Idiopathic portal hypertension, usually with esophageal varices, minimal but definitely abnormal liver tests and subtle or no changes on percutaneous liver biopsy has been reported in only a few patients. A case associated with Felty's syndrome in a 65-year old woman with a 44-year history of rheumatoid arthritis is reported in which the liver tests and liver biopsy were normal. Portal hypertension, varices and a patent portal venous system were documented. No surgical procedure was undertaken and she has done well in the 18 months since these studies were performed. A conservative approach is probably warranted in such cases.