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Mepolizumab EGPA MIRRA — SCE Rheumatology MCQ

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HardVasculitisMepolizumab EGPA MIRRASCE Rheumatology

A patient with persistent lupus anticoagulant develops renal, adrenal, pulmonary and cerebral thromboses over 5 days with thrombocytopenia and microangiopathic haemolysis. Sepsis is being treated and catastrophic APS is strongly suspected. What is the core immuno-thrombotic regimen?

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Correct answer: B — Start therapeutic anticoagulation plus high-dose glucocorticoid and plasma exchange or IVIG while treating the trigger

Explanation lettering: D = shown as A · E = shown as B · A = shown as C · B = shown as D · C = shown as E

E is correct. EULAR supports immediate combination therapy for catastrophic APS: therapeutic anticoagulation, high-dose glucocorticoid and plasma exchange or IVIG, alongside treatment of infection or another precipitant. A is too slow and omits immunomodulation. B is reserved as an addition when active SLE drives CAPS. C cannot safely or effectively address diffuse ongoing thrombosis. D is a rescue consideration in refractory disease, not a substitute for first-line triple therapy.

Reference: EULAR recommendations for antiphospholipid syndrome: https://ard.bmj.com/content/78/10/1296