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Diffuse Systemic Sclerosis — RACP Adult Medicine MCQ

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HardRheumatologyDiffuse Systemic SclerosisRACP Adult Medicine

A 62-year-old with primary Sjögren disease develops persistent unilateral parotid enlargement, palpable purpura, low C4, cryoglobulinaemia and weight loss. What is the most important next step?

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Correct answer: BUrgently investigate for Sjögren-associated B-cell lymphoma with tissue diagnosis

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

C is correct. Persistent asymmetric gland enlargement plus constitutional symptoms, purpura, cryoglobulinaemia and low complement are lymphoma red flags requiring urgent imaging and biopsy planning. D delays diagnosis. E cannot explain systemic features. A assumes infection without supportive signs. B ignores a systemic lymphoproliferative phenotype.

Reference: Australian Rheumatology Association, Sjogren disease: https://rheumatology.org.au/For-Patients/Adult-Medication-Information/Sjogrens-Syndrome