BI21 Intermittent and progressive pustular psoriasis during chemotherapy cycles in a toddler
Notice bibliographique
Résumé
Abstract An 18-month-old with high-risk stage IV neuroblastoma was referred for the difficult evaluation of an intermittent and evolving rash. He presented with erythematous, pruritic papules on his chest, under his portal catheter dressing. After a change of dressing type, this progressed, with a pustular, pruritic eruption across his scalp. Differential diagnoses included eosinophilic folliculitis, contact dermatitis and transfusion reaction. Viral and bacterial swabs and an open application test to chlorhexidine were negative. Topical betamethasone valerate 0.1% gave improvement. Just before his next chemotherapy cycle (cisplatin and etoposide), the rash recurred as a pruritic pustular eruption across the frontal and retroauricular scalp; skin biopsy suggested nonspecific subacute eczematous dermatitis. A lack of eosinophils was suspicious, but blood counts showed absent circulating eosinophils. From December to April, the rash regularly improved after chemotherapy but then recurred and progressed as counts recovered prior to his next cycle. Differentials including Demodex, Pityrosporum, dermatitis with koebnerization and chemotherapy reactions such as neutrophilic eccrine hidradenitis were considered. Topical ivermectin and ketoconazole did not help. He had partial response to topical corticosteroids including clobetasol propionate 0.05%. A second biopsy was taken due to clinical suspicion of psoriasis, and 10 days of oral prednisolone was given to try to clear his skin for autologous stem cell transplantation (HSCT). Biopsy described acanthosis and elongated rete ridges, parakeratosis with neutrophils, and blood vessels extending into dermal papillae in keeping with psoriasis. Fortunately the condition improved substantially and he successfully underwent HSCT with granulocyte colony-stimulating factor (GCSF). For the following 2 months’ cycles, the rash did not recur, but after his second HSCT with GCSF it recurred and continued to spread as cell counts normalized. A few isolated face and scalp lesions quickly spread with pruritic erythematous papules. Many had scale, some had a collarette of scale, and some were pustular and some hyperpigmented. They were extensive over the back with less abdominal involvement. Herpes simplex virus and varicella zoster virus swabs, KOH scrapes and human herpesvirus-6 were negative. He was treated with topical calcipotriol and mometasone 0.1%, with consideration of acitretin should he not improve. Fortunately, the rash settled with topical therapy and time. After completing proton radiotherapy prior to tumour resection, he had six cycles of maintenance immunotherapy (dinutuximab) with no recurrence of the rash, despite monthly GCSF, and good cell counts, and has now completed his oncological therapy.
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) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,000 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 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 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 ».