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ANCA vasculitis — RCPSC IM MCQ

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HardRheumatologyANCA vasculitisRCPSC IM

A 69-year-old man has hemoptysis, mononeuritis multiplex and rapidly rising creatinine. Urine microscopy shows red cell casts, CT chest shows alveolar hemorrhage, PR3-ANCA is strongly positive, and kidney biopsy shows pauci-immune necrotising crescentic glomerulonephritis. What is the most appropriate management?

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Correct answer: D — High-dose glucocorticoids plus rituximab or cyclophosphamide induction

Organ-threatening ANCA-associated vasculitis with pulmonary hemorrhage and crescentic glomerulonephritis requires urgent induction with high-dose glucocorticoids plus rituximab or cyclophosphamide. Supportive care alone is inadequate.

Reference: KDIGO ANCA vasculitis guideline; Canadian rheumatology practice