17th January 2024

A 50-year-old woman attends the GP with a several-month history of shortness of breath, cough, purpuric rash on her lower legs and fatigue.

A 50-year-old woman attends the GP with a several-month history of shortness of breath, cough, purpuric rash on her lower legs and fatigue. She is an ex-smoker and otherwise usually fit and well. Her FBC was borderline normal, and her CRP was moderately raised. LFTs and UEs were normal. She was given several courses of antibiotics for a presumed LRTI and steroid cream, and emollient for her rash but has shown little improvement in her symptoms. Her GP is concerned that this presentation could indicate something more serious, so she is referred to secondary care for further investigation. A chest CT is done to look for evidence of any acute disease and shows a few cavitating nodules. She subsequently has a positive c-ANCA/PR3 ANCA, and her CRP remains elevated, as does her ESR. A lung biopsy is positive for granulomatous inflammation. She is seen in clinic and informed that her investigations and symptoms are in keeping with a diagnosis of granulomatosis with polyangiitis (GPA). Based on this information, which one of the following regimes would be appropriate as an option for an initial induction regime for this patient? 

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