A case of HIV-associated multicentric Castleman disease with pulmonary involvement
Bibliographic record
Abstract
Multicentric Castleman disease (MCD) is a rare lymphoproliferative disorder that is increasingly diagnosed in patients with HIV infection. The course of the disease is unpredictable, ranging from a rapidly progressive form that can be fatal within weeks to a long course of a remitting and relapsing disease. Its principal manifestations are diverse but almost always include fever, malaise, lymphadenopathy and hepatosplenomegaly. Pulmonary manifestations are rare. We report a case of HIV-associated MCD that relapsed after being on remission for 10 years. The patient presented with recurrent “attacks” of classical symptoms (fever, night sweats, polyadenopathy), accompanied by rhinorrhea, shortness of breath and cough. A diffuse interstitial pneumonitis was found on CT-scan of the chest, described as a ground-glass infiltrate with peri-lymphatic micronodules and interlobular thickening that affected mostly the inferior third of both lungs. A slight bilateral pleural effusion was also noted. Lung function tests were normal. Final diagnosis of MCD was made on lymph node biopsy. We first treated this patient with Rituximab alone which led to a rapid relief of his symptoms and radiologic improvement. However, as he relapsed twice following this treatment, each time with systemic symptoms accompanied by a radiologic progression of the diffuse interstitial pneumopathy, we opted for a combined regimen of Rituximab and chemotherapy (CHOP). He is still on remission (6 months) and a follow-up CT-scan shows an almost complete regression of the pulmonary interstitial anomalies. The long term management of MCD presenting with pulmonary involvement has yet to be defined, as long term prognosis.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.002 | 0.002 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.003 | 0.002 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.006 | 0.004 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
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 source (direct Gemma or distilled Codex), 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".