Diagnosis of autoimmune disease in the setting of immunodeficiency
Bibliographic record
Abstract
Case A 41-year-old male presented with abdominal pain, diarrhea, weakness, and shock. He was diagnosed with cardiac tamponade, underwent pericardial drainage and initiation of broad-spectrum antibiotics. The patient had a recent admission with bilateral pleural effusions, with negative infectious and malignancy workup. Macrocytic anemia, increased white blood cells, incidental abdominal abscess and splenic infarcts were found during this admission. Investigations again demonstrated elevated white blood cells (53.8% neutrophils, 12.1% lymphocytes, 29.7% monocytes) and anemia. Autoimmune workup was unremarkable except for presence of atypical ANCA and lupus inhibitor. Bone marrow biopsy was non-specific. He had low IgM and IgG levels suggesting a diagnosis of Common Variable Immunodeficiency (CVID). He received intravenous Solumedrol after his respiratory status deteriorated. He improved and was transitioned to prednisone, but a pathogen was never found. His positive response to steroids with worsening symptoms with prednisone taper initiation suggested that this was an autoimmune process. He was started on Hydroxychloroquine and intravenous immunoglobulin by Rheumatology. However he was subsequently diagnosed with Chronic Myelomonocytic Leukemia (CMML) based on cytogenetic studies by Hematology. Current treatment includes hydroxyurea and prednisone. Discussion This patient demonstrates the challenge of diagnosing autoimmunity in a patient with low levels of immunoglobulins such as in CVID. How to interpret autoimmune antibody titres in autoimmune conditions is unknown. Most literature describes immunodeficiency being diagnosed after the autoimmune condition [1] and often after immunosuppressant use. Studies on systemic lupus erythematosus and CVID have shown low levels of autoantibodies after immunodeficiency diagnosis.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.002 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".