A 43-year-old female with a history of anti-cyclic citrullinated peptide (anti-CCP) and rheumatoid factor seropositive rheumatoid arthritis was sent to outpatient clinic with a diagnosis of neutropenia. She has not had any recent infections. Her rheumatoid arthritis mainly affects her hands and has been under control with etanercept therapy.
During her physical exam, you notice her spleen is 4 cm below the costal margin, and she has bilateral swelling of the MCP joints; otherwise all other findings are normal. Lab reports CBC report: WBC 8900/µL, Absolute Neutrophil Count 451/µL, Absolute Lymphocyte Count 7900/µL, Hgb 10.5 g/dl, MCV 89 fL, PLT 325k/µL Her peripheral smear was investigated and more than 60 percent of WBCs are similar to the cell seen in the attached image. Flow cytometry of the peripheral blood shows CD3 + CD4 - CD8 + CD57 + TCRαβ + immunophenotype of the lymphocytes.…
