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PML on Rituximab — SCE Rheumatology MCQ

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HardRheumatology EmergenciesPML on RituximabSCE Rheumatology

A patient receiving rituximab develops subacute cognitive decline, hemiparesis and asymmetric non-enhancing white-matter lesions. Which infection causes the principal concern?

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Correct answer: EJC polyomavirus causing progressive multifocal leukoencephalopathy

Progressive multifocal leukoencephalopathy results from JC-virus reactivation during impaired cellular or humoral immunity. Rituximab must be withheld and urgent neurology, MRI and CSF JC-virus PCR assessment arranged.

Reference: BSR biologic DMARD safety guideline in inflammatory arthritis — executive summary (Published 2019; update in development): https://academic.oup.com/rheumatology/article/58/2/220/5076445; BNF: rituximab (Current BNF monograph, accessed 30 July 2026): https://bnf.nice.org.uk/drugs/rituximab/