Diagnosis of Felty Syndrome prior to onset of Rheumatoid Arthritis

Diagnosis of Felty Syndrome prior to onset of Rheumatoid Arthritis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Diagnosis of Felty Syndrome prior to onset of Rheumatoid Arthritis Rylee Samander, Timothy Moore, MD This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2515704/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Felty Syndrome is the triad of rheumatoid arthritis, neutropenia, and splenomegaly. The cause of Felty Syndrome is unknown, but neutropenia is thought to be due to a disruption in the balance between granulocyte production and removal. There is splenomegaly due to sequestration of faulty blood cells, fostering an extra-hematopoietic site. Felty Syndrome usually presents many years after diagnosis of rheumatoid arthritis and affects 1–2% of rheumatoid arthritis cases. There have been only 2 documented cases of Felty Syndrome occurring prior to the onset of rheumatoid arthritis making it a rare presentation but should be on the differential diagnosis. The medical management of Felty Syndrome includes treating the underlying cause of Rheumatoid Arthritis with systemic steroids and disease modifying anti-rheumatic drugs (DMARDs) such as methotrexate. For Felty syndrome that is refractory to medical therapy as in this case, splenectomy is usually successful. In this case presentation, this patient presented with splenomegaly and neutropenia but had not had a diagnosis of rheumatoid arthritis. The patient later tested positive for anti-CCP antibody, confirming a diagnosis of rheumatoid arthritis. Days after initial admission, the patient had onset of wrist swelling, likely from the rheumatoid arthritis. This case was complex and multiple therapies were trialed, but eventually the patient underwent a splenectomy. In conclusion, Felty Syndrome, although rare in patients with years of rheumatoid arthritis, should be considered in patients who present with splenomegaly and neutropenia and do not have a known diagnosis of rheumatoid arthritis. If caught and treated early, splenectomy may be avoided and the joint damage from rheumatoid arthritis halted. felty syndrome rheumatoid arthritis splenectomy neutropenia Case Report Rheumatology was consulted on a 26-year-old female hospitalized patient for evaluation of severe pancytopenia, hepatosplenomegaly, and high titers of rheumatoid factor (RF) > 1000 and Anti-CCP Ab > 300. At the time, the patient denied joint pains and her physical exam revealed no synovitis, rheumatoid nodules, or deformities suggestive of active rheumatoid arthritis. Her pancytopenia was treated with transfusions of platelets and blood, systemic steroids, and G-CSF, but her pancytopenia had only minimal and brief improvements with these interventions. 4 months later, the patient presented to the Emergency Department with hemoptysis, fevers, fatigue, and abdominal pain and was subsequently admitted for further testing. Review of systems was positive for fevers, hemoptysis, abdominal discomfort, and wrist pain. Physical examination revealed a thin, ill appearing patient in moderate distress. Cardiopulmonary examination was normal other than tachycardia. The abdomen was diffusely distended and tender to palpation with splenomegaly, and musculoskeletal exam revealed left wrist warmth and swelling with frank synovitis but no joint effusion. Lab results revealed WBC nadir of 0.8, anemia with hemoglobin of 6.4, HCT 20%, and platelet count as low as 5. ESR was elevated at 34 and ANA was negative. Abdominal CT showed hepatosplenomegaly with numerous enhancing liver lesions. Differential diagnosis included: Thrombotic Thrombocytopenic Purpura (TTP), Large Granular Lymphocytic (LGL) leukemia, hemophagocytic lymphohistiocytosis (HLH) and Felty Syndrome. Bone marrow biopsy and peripheral blood smear with flow were unremarkable for HLH or LGL. Bone marrow biopsy revealed peripheral blood with normocytic anemia, neutropenia, and thrombocytopenia; normocellular bone marrow (70–80%) with trilineage hematopoiesis and maturation, with mild erythroid hyperplasia; no evidence of acute leukemia, lymphoma or high grade myelodysplastic syndrome (MDS). A liver biopsy revealed extensive extramedullary hematopoiesis. TTP was ruled out with a negative anti-ADAMTS-13 Antibody and no evidence of microangiopathic hemolytic anemia. Once infections were felt to be excluded, the patient was treated with methotrexate 15mg weekly, prednisone 60mg daily, and a trial of IVIG was initiated. A lymph node biopsy was obtained and revealed hemophagocytosis suggesting the possibility of HLH, a repeat bone marrow biopsy showed trilineage hematopoiesis and no HLH. With minimally abnormal liver function tests, normal ferritin, normal triglycerides, and lack of persistent fevers, HLH was felt to be unlikely. She was ultimately diagnosed with Felty syndrome associated with palindromic rheumatism pattern of onset of rheumatoid arthritis. For persistent and severe pancytopenia despite IVIG, methotrexate and high dose steroids, Anakinra, an anti-IL-1 antibody was initiated. Case reports have shown refractory Felty syndrome responding to Anakinra, but in her case the pancytopenia was unchanged, and the patient eventually underwent a splenectomy. The spleen was 18.5cm in length and showed evidence of extramedullary hematopoiesis with hemophagocytosis in an adjacent lymph node. The patient was unable to follow up in clinic after initial discharge. She was discharged with improvement in her labs, but quickly became septic and was re-admitted for further care. However, following the splenectomy, her CBC did show improvements with hemoglobin measured at 11.6 and platelets at 120. Felty Syndrome is the triad of rheumatoid arthritis, neutropenia, and splenomegaly. [4] The cause of Felty Syndrome is unknown, but neutropenia is thought to be due to a disruption in the balance between granulocyte production and removal which causes neutropenia. [3] There is splenomegaly due to sequestration of faulty blood cells, fostering an extra-hematopoietic site. [2] Felty Syndrome usually presents years after diagnosis of rheumatoid arthritis and affects 1–2% of rheumatoid arthritis cases. There have been only 2 documented cases of Felty Syndrome occurring prior to the onset of rheumatoid arthritis [1]. The medical management of Felty Syndrome includes treating the underlying cause of Rheumatoid Arthritis with systemic steroids and disease modifying anti-rheumatic drugs (DMARDs) such as methotrexate. For Felty syndrome that is refractory to medical therapy as in this case, splenectomy is usually successful [5]. Declarations Ethical Approval and Consent to Participate: Informed consent was obtained from the patient and no HIPAA violations recorded. Consent for publication was obtained by all parties. Availability of data and materials: Not applicable Competing interests: Not applicable Funding: Not applicable Acknowledgment: I would like to thank Dr. Moore for his help in this case report, as well as taking the time to teach me and giving me an insight into rheumatology. Author's Contribution: Not applicable Funding sources: None. Conflict of Interest Disclosure: None declared. This report has not been published previously. References Serrano Santiago VE, Morgan Z. The Diagnosis Felt(y) Right: A Case Report of Felty Syndrome With Limited Articular Involvement. Cureus. 2022 Apr 29;14(4):e24593. doi: 10.7759/cureus.24593. PMID: 35602797; PMCID: PMC9113736. Kay MD, Jonathan. Clinical Manifestations and Diagnosis of Felty Syndrome. UpToDate; 2021 Nov 2. https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-felty-syndrome?search=felty+syndrome&source=search_result&selectedTitle=1~150&usage_type=defdefa&display_rank=1 Peng S. Felty’s syndrome. Medical Encyclopedia. MedlinePlus. Update Date: 10/24/2003. 3pp. www.nlm.nih.gov/medlineplus/ency/article/000445/htm McKusick VA, ed. Online Mendelian Inheritance In Man (OMIM). The Johns Hopkins University. Felty Syndrome. Entry Number; 134750. Last Edit Date; 10/9/2000 Laszlo J, Jones R, Silberman HR, Banks PM. Splenectomy for Felty's Syndrome: Clinicopathological Study of 27 Patients. Arch Intern Med. 1978;138(4):597–602. doi:10.1001/archinte.1978.03630280059020 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2515704","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":174341983,"identity":"3c876312-e7dd-4393-8bd5-75a49da51929","order_by":0,"name":"Rylee Samander","email":"","orcid":"","institution":"Burrell College of Osteopathic Medicine","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Rylee","middleName":"","lastName":"Samander","suffix":""},{"id":174341986,"identity":"2d05e4be-f3af-485e-aa10-05a2a7a18a7f","order_by":1,"name":"Timothy Moore, MD","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAr0lEQVRIiWNgGAWjYPACGzkGCWLV8kCoNGOStRxObCBai73Y4YOPKyrS0rdLtz9g+LinlghbpNOSDc+cscndOeeMAeOMZ8eJ0ZJjJtnYlpa74UYOAzPPgWPEavl3ON3gRvoDUrQ0HE4wuJFgANRSQ4SW20C/NBxLM9w5I8fg4IwDBwhrYZ+dfPBhQ42NvLlE+sMHHw7UEdYCBwZADLTiMIlagIAUW0bBKBgFo2CkAAA5Wzry+9ZD9QAAAABJRU5ErkJggg==","orcid":"","institution":"Kaseman Rheumatology Physician","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Timothy","middleName":"","lastName":"Moore","suffix":"MD"}],"badges":[],"createdAt":"2023-01-26 02:44:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2515704/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2515704/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":33086010,"identity":"d3cbc0a8-e360-404c-bbc0-ff908183ca0a","added_by":"auto","created_at":"2023-02-17 13:29:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":121437,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2515704/v1/fb93081d-69d4-43ac-b529-6e0260273ed7.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Diagnosis of Felty Syndrome prior to onset of Rheumatoid Arthritis","fulltext":[{"header":"Case Report","content":"\u003cp\u003eRheumatology was consulted on a 26-year-old female hospitalized patient for evaluation of severe pancytopenia, hepatosplenomegaly, and high titers of rheumatoid factor (RF)\u0026thinsp;\u0026gt;\u0026thinsp;1000 and Anti-CCP Ab\u0026thinsp;\u0026gt;\u0026thinsp;300. At the time, the patient denied joint pains and her physical exam revealed no synovitis, rheumatoid nodules, or deformities suggestive of active rheumatoid arthritis. Her pancytopenia was treated with transfusions of platelets and blood, systemic steroids, and G-CSF, but her pancytopenia had only minimal and brief improvements with these interventions. 4 months later, the patient presented to the Emergency Department with hemoptysis, fevers, fatigue, and abdominal pain and was subsequently admitted for further testing. Review of systems was positive for fevers, hemoptysis, abdominal discomfort, and wrist pain.\u003c/p\u003e \u003cp\u003ePhysical examination revealed a thin, ill appearing patient in moderate distress. Cardiopulmonary examination was normal other than tachycardia. The abdomen was diffusely distended and tender to palpation with splenomegaly, and musculoskeletal exam revealed left wrist warmth and swelling with frank synovitis but no joint effusion. Lab results revealed WBC nadir of 0.8, anemia with hemoglobin of 6.4, HCT 20%, and platelet count as low as 5. ESR was elevated at 34 and ANA was negative. Abdominal CT showed hepatosplenomegaly with numerous enhancing liver lesions. Differential diagnosis included: Thrombotic Thrombocytopenic Purpura (TTP), Large Granular Lymphocytic (LGL) leukemia, hemophagocytic lymphohistiocytosis (HLH) and Felty Syndrome. Bone marrow biopsy and peripheral blood smear with flow were unremarkable for HLH or LGL. Bone marrow biopsy revealed peripheral blood with normocytic anemia, neutropenia, and thrombocytopenia; normocellular bone marrow (70\u0026ndash;80%) with trilineage hematopoiesis and maturation, with mild erythroid hyperplasia; no evidence of acute leukemia, lymphoma or high grade myelodysplastic syndrome (MDS). A liver biopsy revealed extensive extramedullary hematopoiesis. TTP was ruled out with a negative anti-ADAMTS-13 Antibody and no evidence of microangiopathic hemolytic anemia.\u003c/p\u003e \u003cp\u003eOnce infections were felt to be excluded, the patient was treated with methotrexate 15mg weekly, prednisone 60mg daily, and a trial of IVIG was initiated. A lymph node biopsy was obtained and revealed hemophagocytosis suggesting the possibility of HLH, a repeat bone marrow biopsy showed trilineage hematopoiesis and no HLH. With minimally abnormal liver function tests, normal ferritin, normal triglycerides, and lack of persistent fevers, HLH was felt to be unlikely. She was ultimately diagnosed with Felty syndrome associated with palindromic rheumatism pattern of onset of rheumatoid arthritis. For persistent and severe pancytopenia despite IVIG, methotrexate and high dose steroids, Anakinra, an anti-IL-1 antibody was initiated. Case reports have shown refractory Felty syndrome responding to Anakinra, but in her case the pancytopenia was unchanged, and the patient eventually underwent a splenectomy. The spleen was 18.5cm in length and showed evidence of extramedullary hematopoiesis with hemophagocytosis in an adjacent lymph node. The patient was unable to follow up in clinic after initial discharge. She was discharged with improvement in her labs, but quickly became septic and was re-admitted for further care. However, following the splenectomy, her CBC did show improvements with hemoglobin measured at 11.6 and platelets at 120.\u003c/p\u003e \u003cp\u003eFelty Syndrome is the triad of rheumatoid arthritis, neutropenia, and splenomegaly. [4] The cause of Felty Syndrome is unknown, but neutropenia is thought to be due to a disruption in the balance between granulocyte production and removal which causes neutropenia. [3] There is splenomegaly due to sequestration of faulty blood cells, fostering an extra-hematopoietic site. [2] Felty Syndrome usually presents years after diagnosis of rheumatoid arthritis and affects 1\u0026ndash;2% of rheumatoid arthritis cases. There have been only 2 documented cases of Felty Syndrome occurring prior to the onset of rheumatoid arthritis [1]. The medical management of Felty Syndrome includes treating the underlying cause of Rheumatoid Arthritis with systemic steroids and disease modifying anti-rheumatic drugs (DMARDs) such as methotrexate. For Felty syndrome that is refractory to medical therapy as in this case, splenectomy is usually successful [5].\u003c/p\u003e"},{"header":"Declarations","content":"\u003col\u003e\n \u003cli\u003eEthical Approval and Consent to Participate: Informed consent was obtained from the patient and no HIPAA violations recorded.\u003c/li\u003e\n \u003cli\u003eConsent for publication was obtained by all parties.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eAvailability of data and materials: Not applicable\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eCompeting interests: Not applicable\u003c/li\u003e\n \u003cli\u003eFunding: Not applicable\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eAcknowledgment: I would like to thank Dr. Moore for his help in this case report, as well as taking the time to teach me and giving me an insight into rheumatology.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eAuthor\u0026apos;s Contribution: Not applicable\u0026nbsp;\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eFunding sources:\u003c/strong\u003e None.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest Disclosure:\u003c/strong\u003e None declared.\u003c/p\u003e\n\u003cp\u003eThis report has not been published previously.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eSerrano Santiago VE, Morgan Z. The Diagnosis Felt(y) Right: A Case Report of Felty Syndrome With Limited Articular Involvement. Cureus. 2022 Apr 29;14(4):e24593. doi: 10.7759/cureus.24593. PMID: 35602797; PMCID: PMC9113736.\u003c/li\u003e\n \u003cli\u003eKay MD, Jonathan. Clinical Manifestations and Diagnosis of Felty Syndrome. UpToDate; 2021 Nov 2. https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-felty-syndrome?search=felty+syndrome\u0026amp;source=search_result\u0026amp;selectedTitle=1~150\u0026amp;usage_type=defdefa\u0026amp;display_rank=1\u0026nbsp;\u003c/li\u003e\n \u003cli\u003ePeng S. Felty\u0026rsquo;s syndrome. Medical Encyclopedia. MedlinePlus. Update Date: 10/24/2003. 3pp. www.nlm.nih.gov/medlineplus/ency/article/000445/htm\u003c/li\u003e\n \u003cli\u003eMcKusick VA, ed. Online Mendelian Inheritance In Man (OMIM). The Johns Hopkins University. Felty Syndrome. Entry Number; 134750. Last Edit Date; 10/9/2000\u003c/li\u003e\n \u003cli\u003eLaszlo J, Jones R, Silberman HR, Banks PM. Splenectomy for Felty\u0026apos;s Syndrome: Clinicopathological Study of 27 Patients. Arch Intern Med. 1978;138(4):597\u0026ndash;602. doi:10.1001/archinte.1978.03630280059020\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"felty syndrome, rheumatoid arthritis, splenectomy, neutropenia ","lastPublishedDoi":"10.21203/rs.3.rs-2515704/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2515704/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eFelty Syndrome is the triad of rheumatoid arthritis, neutropenia, and splenomegaly. The cause of Felty Syndrome is unknown, but neutropenia is thought to be due to a disruption in the balance between granulocyte production and removal. There is splenomegaly due to sequestration of faulty blood cells, fostering an extra-hematopoietic site. Felty Syndrome usually presents many years after diagnosis of rheumatoid arthritis and affects 1\u0026ndash;2% of rheumatoid arthritis cases. There have been only 2 documented cases of Felty Syndrome occurring prior to the onset of rheumatoid arthritis making it a rare presentation but should be on the differential diagnosis. The medical management of Felty Syndrome includes treating the underlying cause of Rheumatoid Arthritis with systemic steroids and disease modifying anti-rheumatic drugs (DMARDs) such as methotrexate. For Felty syndrome that is refractory to medical therapy as in this case, splenectomy is usually successful.\u003c/p\u003e \u003cp\u003eIn this case presentation, this patient presented with splenomegaly and neutropenia but had not had a diagnosis of rheumatoid arthritis. The patient later tested positive for anti-CCP antibody, confirming a diagnosis of rheumatoid arthritis. Days after initial admission, the patient had onset of wrist swelling, likely from the rheumatoid arthritis. This case was complex and multiple therapies were trialed, but eventually the patient underwent a splenectomy.\u003c/p\u003e \u003cp\u003eIn conclusion, Felty Syndrome, although rare in patients with years of rheumatoid arthritis, should be considered in patients who present with splenomegaly and neutropenia and do not have a known diagnosis of rheumatoid arthritis. If caught and treated early, splenectomy may be avoided and the joint damage from rheumatoid arthritis halted.\u003c/p\u003e","manuscriptTitle":"Diagnosis of Felty Syndrome prior to onset of Rheumatoid Arthritis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-02-09 11:29:32","doi":"10.21203/rs.3.rs-2515704/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"527d9b31-f980-4f04-85d9-8577b7035ef3","owner":[],"postedDate":"February 9th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2023-02-17T13:29:31+00:00","versionOfRecord":[],"versionCreatedAt":"2023-02-09 11:29:32","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-2515704","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2515704","identity":"rs-2515704","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}