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Ascending cholangitis — RCPSC IM MCQ

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HardGastroenterology/HepatologyAscending cholangitisRCPSC IM

A patient has rapidly progressive glomerulonephritis, pulmonary hemorrhage and positive PR3-ANCA. Infection has been reasonably excluded. Which management principle is appropriate?

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Correct answer: C — Start glucocorticoid with rituximab or cyclophosphamide

The best answer is “Start glucocorticoid with rituximab or cyclophosphamide”. Pulmonary-renal ANCA vasculitis is organ threatening and requires prompt remission induction with glucocorticoid plus rituximab or cyclophosphamide. Methotrexate is for selected nonsevere disease, titers do not justify delay, and plasma exchange is a context-specific adjunct rather than complete induction.

Reference: CanVasc recommendations for ANCA-associated vasculitis: https://pmc.ncbi.nlm.nih.gov/articles/PMC5004812/