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PJP on Rituximab — RACP Adult Medicine MCQ

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HardInfectious DiseasesPJP on RituximabRACP Adult Medicine

A patient presents with bruising, pancytopenia, low fibrinogen, high D-dimer and promyelocytes with suspected PML::RARA acute promyelocytic leukaemia. Molecular confirmation is pending. What is the most important immediate disease-directed step?

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

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Correct answer: D — Commence ATRA immediately while supporting coagulopathy and confirming the diagnosis

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

E is correct. Suspected APML is a haematological emergency; immediate ATRA and aggressive blood-product support reduce early haemorrhagic death while confirmation proceeds. A and B delay the differentiating agent. C worsens bleeding. D lumbar puncture is unsafe during coagulopathy and must not delay treatment.

Reference: eviQ, Acute promyelocytic leukaemia differentiation syndrome: https://www.eviq.org.au/clinical-resources/side-effect-and-toxicity-management/prophylaxis-and-treatment/1752-acute-promyelocytic-leukaemia-differentiation