A 62-year-old man presents with rapidly progressive glomerulonephritis, hemoptysis, and sinusitis. cANCA/PR3-ANCA is strongly positive. Renal biopsy shows pauci-immune crescentic glomerulonephritis. This is granulomatosis with polyangiitis (GPA). Induction therapy consists of:
- A High-dose prednisolone alone
- B Azathioprine plus corticosteroids
- C Rituximab plus high-dose corticosteroids ✓
- D Mycophenolate mofetil plus corticosteroids
Correct answer: C. Rituximab plus high-dose corticosteroids
Explanation
Induction therapy for severe ANCA-associated vasculitis (GPA/MPA) with organ-threatening disease uses rituximab (anti-CD20) plus high-dose corticosteroids; rituximab is non-inferior to cyclophosphamide (RAVE trial) and is now preferred due to a better long-term toxicity profile. Azathioprine and mycophenolate are used for maintenance remission, not induction. Corticosteroids alone are insufficient for severe GPA.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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