067. PULMONARY INVOLVEMENT IN GIANT CELL ARTERITIS MIMIC
Notice bibliographique
Résumé
Background: Giant cell arteritis (GCA) is the most common form of vasculitis that affects people aged over 50 years. GCA is a medical emergency that often progresses rapidly and, if left untreated. Case Description: An 82-year-old gentleman was admitted to our hospital with new onset headache, jaw claudication and c-reactive protein (CRP) 300mg/dL. Past history included repaired aortic aneurysm (2008) and obstructive lung disease. Diagnostic work-up including temporal artery biopsy (TAB) was negative. However, he was diagnosed with GCA and started on 60 mg prednisone. He was referred for a GCA ultrasound (US) assessment which revealed bilateral positive halo sign with involvement of the frontal, parietal, facial and occipital branches. Treatment resulted in moderate improvement in his headache. One week after prednisone was reduced to 50mg, he suffered a severe relapse with headache and jaw claudication. He was admitted to hospital where immunological serology was negative with a CRP 100mg/dL and CT chest showed pulmonary infiltrates. There was hesitation from the pulmonary service to investigate further with bronchoscopy, as they felt the pulmonary manifestations were due to GCA. Three days of treatment with 1g methylprednisolone led to rapid symptom resolution and CRP reduction to 30mg/dL. Prednisone was continued at 50mg/d but attempts to taper to 45mg resulted in flares with severe headaches and bilateral temporal artery halo sign progression on serial US assessment. Investigation with PET scan showed multiple lung infiltrations and bilateral temporal artery uptake. The patient later disclosed that his brother was treated for tuberculosis (TB) 30 years ago which raised concern for TB. Diagnostic work-up with bronchoscopy surprisingly revealed pneumocystis jiroveci. Currently, the patient is on treatment with 28mg of methylprednisolone and trimethoprim and sulfamethoxazole with consideration for immunosuppression given the inability to taper prednisone. Discussion: Pulmonary manifestations of GCA are nonspecific and rare. Upper tract symptoms include sore throat and cough. Lower tract involvement includes pulmonary nodules, interstitial infiltrates, alveolitis and subclinical hemorrhage. Occam would have us consider that this patient had a rare manifestation of uncommon disease. Whereas, Hickam would correctly advise us that a second more common disease process such as infection induced by treatment is likely. Conclusion: It is vital to rule out common causes of pulmonary manifestations when treating vasculitis patients. Disclosure: None
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,002 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,010 | 0,005 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».