Rituximab hypogammaglobulinaemia — SCE Rheumatology MCQ

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HardRheumatological PharmacologyRituximab hypogammaglobulinaemiaSCE Rheumatology

A 59-year-old woman receives rituximab for ANCA vasculitis maintenance. She has recurrent sinus and chest infections. IgG is 3.4 g/L, whereas baseline IgG was normal. B-cell counts remain suppressed. CT chest shows bronchiectasis. What is the most important complication to screen for?

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Correct answer: C — Secondary hypogammaglobulinaemia

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

Secondary hypogammaglobulinaemia is best because recurrent infections with low IgG after rituximab suggest secondary hypogammaglobulinaemia. A is less suitable because MAS causes acute hyperinflammatory cytopenic illness; B is less suitable because scleroderma renal crisis causes malignant hypertension and renal failure; C is less suitable because hydroxychloroquine retinopathy causes visual field/OCT abnormalities; E is less suitable because urate nephropathy relates to gout or tumour lysis. Clinical pearl: immunoglobulin levels should be monitored in patients receiving repeated B-cell depletion.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/musculoskeletal-conditions