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Rituximab hypogammaglobulinaemia — SCE Rheumatology MCQ

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HardRheumatological pharmacologyRituximab hypogammaglobulinaemiaSCE Rheumatology

A 71-year-old woman receives rituximab for ANCA-associated vasculitis. Over two years she develops recurrent sinopulmonary infections; IgG is 3.9 g/L and B cells remain depleted. What is the most appropriate management consideration?

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Correct answer: E — Assess for rituximab-associated hypogammaglobulinaemia and immunology input

Recurrent infections with low IgG after rituximab suggest secondary hypogammaglobulinaemia. Immunoglobulin levels should be monitored and immunology input considered, especially if further B-cell depletion is planned. Increasing rituximab would likely worsen the problem.

Reference: BSR biologic DMARD safety guideline; BNF