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Iron deficiency anemia in an older man — ABIM Board MCQ

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HardHematology/OncologyIron deficiency anemia in an older manABIM Board

A 59-year-old has daily nonpruritic urticarial plaques, recurrent fever, bone pain, neutrophilia, elevated CRP, and an IgM-kappa monoclonal protein. Skin biopsy shows neutrophilic urticarial dermatosis without vasculitis. Which treatment most specifically targets the syndrome?

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Correct answer: E — Begin interleukin-1 blockade after excluding important diagnostic mimics

The best answer is “Begin interleukin-1 blockade after excluding important diagnostic mimics”. The obligatory combination of chronic neutrophilic urticarial eruption and monoclonal IgM, together with recurrent fever, inflammation, and bone pain, supports Schnitzler syndrome after infection, malignancy, and other autoinflammatory disorders are assessed. Interleukin-1 blockade, such as anakinra, typically produces a rapid and dramatic response. Antihistamines are usually ineffective because the eruption is not mast-cell mediated, while clone-directed treatment is not automatically first-line.

Reference: Schnitzler syndrome: pathogenesis, manifestations, and management: https://pmc.ncbi.nlm.nih.gov/articles/PMC11202231/