ANCA vasculitis infection prophylaxis — SCE Rheumatology MCQ

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ModerateVasculitisANCA vasculitis infection prophylaxisSCE Rheumatology

A 64-year-old woman starts rituximab and high-dose glucocorticoids for ANCA-associated vasculitis with renal involvement. Her lymphocyte count is low and she will receive several weeks of prednisolone above 20 mg daily. She has no sulfonamide allergy. What is the most appropriate management?

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Correct answer: C — Offer Pneumocystis jirovecii prophylaxis

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

Offer Pneumocystis jirovecii prophylaxis is best because PJP prophylaxis is commonly indicated during intensive immunosuppression for AAV, especially with high-dose glucocorticoids and rituximab/cyclophosphamide. B is less suitable because ciprofloxacin does not prevent vasculitis relapse and is not PJP prophylaxis; C is less suitable because live vaccines are avoided during intense immunosuppression; D is less suitable because colchicine prevents gout flares rather than opportunistic infection; E is less suitable because vaccination review is important before and during immunosuppression planning. Clinical pearl: infection prevention is part of induction therapy, not an afterthought.

Reference: EULAR infection prophylaxis recommendations; BSR ANCA-associated vasculitis recommendations 2025