Cyclophosphamide toxicity — SCE Rheumatology MCQ

Instant feedback + full explanation. One question, done properly.

ModerateRheumatological PharmacologyCyclophosphamide toxicitySCE Rheumatology

A 34-year-old man with severe systemic vasculitis is planned for intravenous cyclophosphamide. He asks about important treatment-related risks. FBC and urinalysis are normal. He wishes to have children in the future. What is the most important complication to screen for?

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

Reveal the answer and explanation

Correct answer: E — Infertility and haemorrhagic cystitis

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

Infertility and haemorrhagic cystitis is best because cyclophosphamide can cause gonadal toxicity and haemorrhagic cystitis, so fertility counselling and uroprotection are important. A is less suitable because Achilles rupture is linked to tendinopathy or fluoroquinolones rather than cyclophosphamide; B is less suitable because PAH is a disease complication in systemic sclerosis, not a classic cyclophosphamide toxicity; C is less suitable because tophi result from chronic gout; E is less suitable because retinal maculopathy is associated with hydroxychloroquine. Clinical pearl: fertility preservation should be discussed before cyclophosphamide whenever feasible.

Reference: BNF; EULAR AAV recommendations 2022