Neutropenia in a Patient With Rheumatoid Arthritis Associated With αβ/γδ T-Cell Large Granular Lymphocyte Lymphoproliferative Disorder Manifesting as Felty’s Syndrome: From Diagnosis to Therapy
Bibliographic record
Abstract
T-cell large granular lymphocytic (LGL) leukaemias are clonal proliferations of cytotoxic T-cells that are frequently associated with rheumatoid arthritis (RA) and neutropenia and are usually controlled with immunosuppressive drugs and growth factors. We report a case of a 51-years-old patient with RA, mild splenomegaly and severe autoimmune neutropenia, who have failed to respond to methotrexate, leflunamide and corticosteroids and had a suspicion of granulocyte-colony stimulating factor (G-CSF) induced thrombocytopenia. The diagnosis of Felty’s syndrome was done and phenotypically abnormal TCR-alpha beta and TCR gamma alpha T-LGL were detected in blood, although PCR-based studies provided evidence only for clonal TCRG gene rearrangements. A second attempt to control neutropenia with G-CSF induced thrombocytopenia again. Cyclosporine A was effective in controlling neutropenia, the dose being adjusted in order to maintain acceptable neutrophil counts and to minimise side effects. These included hypertension, renal insufficiency and gingival hypertrophy, the later being worsened by the concomitant use of amlodipine. J Med Cases. 2013;4(7):450-457 doi: https://doi.org/10.4021/jmc1176w
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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 | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 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 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".