Original article

Rheumatoid arthritis complicated with T-cell large granular lymphocytic leukemia: A case report and literature review

  • Yueyue Zhang ,
  • Meifang Xie ,
  • Gen Sun
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  • 1. Department of Rheumatology and Immunology, the Fourth Affiliated Hospital of Nanjing Medical University, Nanjing 210031, China
    2. Department of Rheumatology and Immunology, Jiangsu Provincial People's Hospital, Nanjing 210029, China
Xie Meifang, Email: meifangxie@126.com

Received date: 2022-04-27

  Online published: 2022-09-26

Abstract

Objective To explore the clinical characteristics of rheumatoid arthritis (RA) complicated with T-cell large granular lymphocytic leukemia (T-LGLL). Methods The study was aiming to retrospectively analyze the clinical data, diagnosis and treatment process of a RA patient complicated with T-LGLL admitted to The Fourth Affiliated Hospital of Nanjing Medical University, and reviewing related literatures. Results The patient was a 64-year-old man with multiple joint swelling and pain for 10 years and fatigue for 2 years. The disease course was complicated with neutropenia and splenomegaly. In combination with the patient's medical history, physical examination and auxiliary examination, the following findings of admission diagnosis were made: RA, Felty's syndrome (FS).The admission diagnosis results (RA, and Ferty's syndrome [FS]) were made in combination with the case history, physical examination, and auxiliary examination.The patient was confirmed to have T-LGLL after supplementing relevant auxiliary examination and combining corresponding clinical manifestations.The patient's fatigue symptoms were improved without joint swelling and painafter the symptomatic treatment of immunosuppressant and glucocorticoid. Conclusion For patients with RA, RA and T-LGLL may have similar pathogenesis. It is necessary to be alert to the possibility of T-LGLL when developing FS.

Cite this article

Yueyue Zhang , Meifang Xie , Gen Sun . Rheumatoid arthritis complicated with T-cell large granular lymphocytic leukemia: A case report and literature review[J]. Clinical Focus, 2022 , 37(8) : 728 -732 . DOI: 10.3969/j.issn.1004-583X.2022.08.010

References

[1] Jin S, Li M, Fang Y, et al. Chinese registry of rheumatoid arthritis (CREDIT): II.prevalence and risk factors of major comorbidities in Chinese patients with rheumatoid arthritis[J]. Arthritis Res Ther, 2017, 19(1): 251.
[2] Dinmohamed AG, Brink M, Visser O, et al. Population-based analyses among 184 patients diagnosed with large granular lymphocyte leukemia in the Netherlands between 2001 and 2013[J]. Leukemia, 2016, 30(6):1449-1451.
[3] Rodrigues L, da Silva GN, de Lacerda AP. Felty's syndrome-a rare case of febrile neutropenia[J]. Arch Clin Cases, 2021, 6(2):48-52.
[4] Turesson C, Jacobsson LT, Sturfelt G, et al. Rheumatoid factor and antibodies to cyclic citrullinated peptides are associated with severe extra-articular manifestations in rheumatoid arthritis[J]. Ann Rheum Dis, 2007, 66(1):59-64.
[5] 符海. 慢性风湿性关节炎新的诊断标准(美国风湿病协会1987年修订)[J]. 临床荟萃, 1991, 6(3):129.
[6] Ko KM, Moon SJ. Prevalence, incidence, and risk factors of malignancy in patients with rheumatoid arthritis: A nationwide cohort study from Korea[J]. Korean J Intern Med, 2021.
[7] Cansu DÜ, Teke HÜ, Bodakçi E, et al. How should we manage low-dose methotrexate-induced pancytopenia in patients with rheumatoid arthritis?[J]. Clin Rheumatol, 2018, 37(12):3419-3425.
[8] Gupta A, Abrahimi A, Patel A. Felty syndrome: A case report[J]. J Med Case Rep, 2021, 15(1):273.
[9] Lamy T, Moignet A, Loughran TP Jr. LGL leukemia: From pathogenesis to treatment[J]. Blood, 2017, 129(9):1082-1094.
[10] Swerdlow SH, Campo E, Pileri SA, et al. The 2016 revision of the World Health Organization classification of lymphoid neoplasms[J]. Blood, 2016, 127(20):2375-2390.
[11] Barilà G, Calabretto G, Teramo A, et al. T cell large granular lymphocyte leukemia and chronic NK lymphocytosis[J]. Best Pract Res Clin Haematol, 2019, 32(3):207-216.
[12] Dearden C. Large granular lymphocytic leukaemia pathogenesis and management[J]. Br J Haematol, 2011, 152(3):273-283.
[13] Moignet A, Lamy T. Latest advances in the diagnosis and treatment of large granular lymphocytic leukemia[J]. Am Soc Clin Oncol Educ Book, 2018, 38:616-625.
[14] Schwaneck EC, Renner R, Junker L, et al. Prevalence and characteristics of persistent clonal T cell large granular lymphocyte expansions in rheumatoid arthritis: A comprehensive analysis of 529 patients[J]. Arthritis Rheumatol, 2018, 70(12):1914-1922.
[15] Gorodetskiy V, Probatova N, Sidorova Y, et al. The non-leukemic T cell large granular lymphocytic leukemia variant with marked splenomegaly and neutropenia in the setting of rheumatoid arthritis - Felty syndrome and hepatosplenic T cell lymphoma mask[J]. Am J Blood Res, 2021, 11(3):227-237.
[16] Gorodetskiy VR, Sidorova YV, Kupryshina NA, et al. Analysis of a single-institution cohort of patients with Felty's syndrome and T-cell large granular lymphocytic leukemia in the setting of rheumatoid arthritis[J]. Rheumatol Int, 2021, 41(1):147-156.
[17] Zhang C, Ma K, Yang Y, et al. Glaucocalyxin A suppresses inflammatory responses and induces apoptosis in TNF-a-induced human rheumatoid arthritis via modulation of the STAT3 pathway[J]. Chem Biol Interact, 2021, 341:109451.
[18] Savola P, Brück O, Olson T, et al. Somatic STAT3 mutations in Felty syndrome: An implication for a common pathogenesis with large granular lymphocyte leukemia[J]. Haematologica, 2018, 103(2):304-312.
[19] Rajala HL, Olson T, Clemente MJ, et al. The analysis of clonal diversity and therapy responses using STAT3 mutations as a molecular marker in large granular lymphocytic leukemia[J]. Haematologica, 2015, 100(1):91-99.
[20] Shi M, He R, Feldman AL, et al. STAT3 mutation and its clinical and histopathologic correlation in T-cell large granular lymphocytic leukemia[J]. Hum Pathol, 2018, 73:74-81.
[21] Lamy T, Loughran TP Jr. How I treat LGL leukemia[J]. Blood, 2011, 117(10):2764-2774.
[22] Lobbes H, Dervout C, Toussirot E, et al. Rituximab for rheumatoid arthritis-associated large granular lymphocytic leukemia, a retrospective case series[J]. Semin Arthritis Rheum, 2020, 50(5):1109-1113.
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