Notice bibliographique
Résumé
Abstract INTRODUCTION Our case illustrates the challenges of diagnosing and treating lung disease in the setting of RA and immunosuppression. CASEA 65 yo female with RA, (treated with rituximab 10 months prior), Myelodysplastic syndrome, remote Aplastic anemia without prior lung disease presented with back pain, cough and lower lobe pulmonary opacities consistent with pneumonia. Her medications included tylenol and naproxen-esomeprazole. She had never smoked, vaped, or used recreational drugs. There were no environmental exposures. She received 10 days of clavulin. Symptoms and labs normalized, however there was incomplete radiographic resolution one month later. Spirometry was normal but there was reduction in diffusing capacity. Three months later, similar symptoms occurred. A CT showed new upper lobe peripheral opacities. White blood cell count and differential was normal. C-reactive protein was 78 m/ mL. On bronchoscopy, all bacterial, fungal, mycobacterial and viral studies were normal. Transbronchial biopsies demonstrated patchy chronic interstitial pneumonitis without granuloma, vasculitis, infection, or malignancy. A working diagnosis of organizing pneumonia was made. She was initiated on prednisone 50 mg OD and PJP prophylaxis in December with a planned 6 month taper. While her respiratory symptoms and pulmonary opacities improved, in March she received rituximab for RA flare. By April, her exertional dyspnea and dry cough reached a plateau. By May, on 15 mg of prednisone, symptoms gradually worsened and forced vital capacity declined by 10%. She denied sputum, fevers, chills, or viral symptoms. Her exam was unremarkable. A CT chest showed bilateral lower lobe opacities, patchy ground glass, minor reticulation, and traction bronchiectasis. Consensus from ILD Multidisciplinary Rounds was that this was connective tissue disease-related ILD and mycophenolate should be initiated. Although no infectious symptoms, out of caution a bronchoscopy was performed. Unexpectedly, the lavage demonstrated Covid and all other investigations were negative. She received 10 days of remdesivir, a dose of intravenous immunoglobulin G, and continued on prednisone 10 mg with rapid resolution of symptoms and improvement of radiographic findings. Ten days of nirmatrelvir with ritonavir were given to facilitate complete Covid clearance. A CT chest 3 months after the admission demonstrated resolution of the majority of abnormalities. DISCUSSION Pulmonary manifestations of RA can include organizing pneumonia, interstitial lung disease, bronchiectasis, pulmonary arterial hypertension, pleural effusion, and increased risk of infection due to immunosuppression. While Covid can also cause organizing pneumonia and pulmonary fibrosis, our case highlights how prolonged Covid infection without classic symptoms or hypoxia can mimic ILD.
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 distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,002 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
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 tête enseignante, 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 ».