skip to main content

PCP in AAV — SCE Rheumatology MCQ

Instant feedback + full explanation. One question, done properly.

ModerateVasculitisPCP in AAVSCE Rheumatology

A 45-year-old man with microscopic polyangiitis in remission receives rituximab maintenance infusions every 6 months. His most recent infusion was 2 months ago. Prednisolone was withdrawn 9 months ago, at which point all antimicrobial prophylaxis was also stopped. He now presents with fever, dry cough and bilateral pulmonary infiltrates. Bronchoalveolar lavage confirms Pneumocystis jirovecii pneumonia. Which prophylactic prescribing error is most consistent with current guidance for ANCA-associated vasculitis?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Premature discontinuation of co-trimoxazole prophylaxis

The correct answer is C. Patients with ANCA-associated vasculitis receiving rituximab should receive Pneumocystis prophylaxis, normally with co-trimoxazole unless contraindicated. Guidance suggests continuing it during rituximab exposure and for approximately 6 months after the final dose or until B-cell reconstitution. Because this patient receives rituximab every 6 months and was infused 2 months ago, stopping prophylaxis when glucocorticoids were withdrawn left him within the expected biological effect period of rituximab. PJP is not inevitable, so A is incorrect. Mould-active antifungals do not prevent Pneumocystis. Varicella-zoster prophylaxis and latent-TB treatment prevent different infections and are not substitutes for PJP prophylaxis.

Reference: Hellmich B et al. EULAR recommendations for the management of ANCA-associated vasculitis: 2022 update, recommendation 17. Annals of the Rheumatic Diseases. 2024;83:30–47. https://ard.bmj.com/content/83/1/30