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SLE infection risk — SCE Rheumatology MCQ

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ModerateConnective Tissue DiseasesSLE infection riskSCE Rheumatology

A 40-year-old woman with SLE on mycophenolate and prednisolone 20 mg presents with fever and cough. Chest radiograph shows right lower-lobe consolidation and CRP is 182 mg/L. Anti-dsDNA is mildly raised but complement is unchanged. Oxygen saturation is 93% on air. What is the most appropriate management?

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

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Correct answer: E — Treat infection and temporarily withhold mycophenolate

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

Treat infection and temporarily withhold mycophenolate is best because focal consolidation with fever and high CRP in an immunosuppressed patient should be treated as infection, with temporary mycophenolate interruption. A is less suitable because gout treatment is unrelated; C is less suitable because lupus pneumonitis is a differential but antibiotics and infection work-up are essential; D is less suitable because escalating mycophenolate would worsen infection risk; E is less suitable because rituximab during acute infection is unsafe. Clinical pearl: not every inflammatory marker rise in SLE is a flare; infection is a frequent mimic.

Reference: EULAR SLE recommendations 2023; BNF