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ANCA vasculitis organ-threatening — SCE Rheumatology MCQ

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ModerateVasculitisANCA vasculitis organ-threateningSCE Rheumatology

A 59-year-old man has PR3-ANCA vasculitis with pulmonary haemorrhage and crescentic glomerulonephritis. Examination shows oxygen saturation is 90% and purpura is present. Investigations show creatinine is 320 micromol/L. What is the most appropriate management?

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Correct answer: E — High-dose glucocorticoid plus rituximab or cyclophosphamide

High-dose glucocorticoid plus rituximab or cyclophosphamide is the best management step because the vignette describes active or organ-threatening vasculitis. The tempting alternatives either delay sight- or organ-saving therapy or treat a different condition. In vasculitis, treatment urgency is determined by organ threat as much as by diagnostic certainty.

Reference: EULAR ANCA-associated vasculitis recommendations; BSR guideline; BNF