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Stevens-Johnson syndrome/toxic epidermal necrolysis — ABIM Board MCQ

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HardDermatologyStevens-Johnson syndrome/toxic epidermal necrolysisABIM Board

A 44-year-old man has biopsy-confirmed PLA2R-associated membranous nephropathy, proteinuria 5.2 g/day, albumin 2.7 g/dL, stable eGFR 92 mL/min/1.73 m2, no thrombosis, and falling PLA2R antibody titers after three months of optimized supportive therapy. What is the best next step?

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Correct answer: A — Continue supportive therapy with serial risk reassessment

The best answer is “Continue supportive therapy with serial risk reassessment”. Immunosuppression is risk-stratified, not triggered by nephrotic-range proteinuria alone. Preserved kidney function, no complication, and a favorable immunologic trend support continued supportive management with reassessment. Persistent high antibody titers, worsening function, severe complications, or sustained high-risk proteinuria would shift the balance toward immunosuppression.

Reference: KDIGO 2021 Clinical Practice Guideline for Glomerular Diseases: https://kdigo.org/wp-content/uploads/2017/02/KDIGO-Glomerular-Diseases-Guideline-2021-English.pdf