1st April 2022

A 70-year-old Asian woman with a 50-year history of ankylosing spondylitis

A 70-year-old Asian woman with a 50-year history of ankylosing spondylitis has been taking bisphosphonates for the past 20 years and 6 weeks ago was very recently started on a weekly SC injection of etanercept for poorly controlled disease. She complains of feeling hot and cold with a productive cough for the last month. She also says she has lost 1 stone in weight since the injections started. She denies any other symptoms when asked about sore throat, ulcers, bruising and bleeding.

Which of the following is the most likely cause?

Select the SINGLE most appropriate option from the list below. Select ONE option only.