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[Clinical Picture] T-cell large granular lymphocytic leukaemia in the context of rheumatoid arthritis

A 64-year-old man was referred for evaluation of neutropenia. The patient complained of bilateral symmetrical pain and morning stiffness in multiple joints, and weight loss, fevers, increased sweating, and fatigue—all of which had been present for 2 months. Physical examination showed bilateral synovitis in the elbow, wrist, metacarpophalangeal, proximal interphalangeal, and ankle joints. There was no lymphadenopathy or splenomegaly.