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Tocilizumab-associated serious infection — SCE Rheumatology MCQ

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HardRheumatoid arthritisTocilizumab-associated serious infectionSCE Rheumatology

A 64-year-old woman with erosive rheumatoid arthritis treated with tocilizumab attends with abdominal pain and malaise. Temperature is 37.3°C, pulse 118/min, blood pressure 92/58 mmHg and abdominal examination shows guarding in the left iliac fossa. Her CRP is 6 mg/L, neutrophils are 15.1 × 10^9/L and lactate is 3.2 mmol/L. What is the most appropriate management?

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Correct answer: A — Treat as suspected intra-abdominal sepsis and arrange urgent surgical review

IL-6 blockade can blunt fever and CRP responses, so sepsis may present with deceptively low inflammatory markers. Hypotension, tachycardia, guarding and raised lactate make urgent sepsis management and surgical review the safest course. A normal CRP should not reassure clinicians in patients receiving tocilizumab.

Reference: BNF; BSR biologic DMARD safety guideline