Before starting rituximab in a patient with rheumatoid arthritis, screening for which infection is mandatory because of the risk of fulminant reactivation?

• A Tuberculosis
• B Hepatitis B virus ✓
• C Strongyloides stercoralis
• D JC polyomavirus

Explanation

B cell-depleting agents remove the humoral arm controlling latent hepatitis B, and rituximab carries the highest risk among biologics for reactivation with fulminant hepatitis, even years after dosing. Antiviral prophylaxis or monitoring is mandated in HBsAg-positive or anti-HBc-positive patients. TB screening applies to TNF inhibitors, strongyloides to high-dose steroids, and progressive multifocal leukoencephalopathy from JC virus is the concern with natalizumab, not rituximab.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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