Bell's palsy in a patient receiving adalimumab for Crohn's disease
Bibliographic record
Abstract
Dear Sir, Adalimumab is a tumor necrosis factor (TNF)-α antagonist used to treat immune-mediated inflammatory disorders, but it also increases the risks of opportunistic infections.1 We present a case of Bell's palsy due to herpes simplex virus (HSV) in a patient on adalimumab for Crohn's disease, which we believe is the first description of Bell's palsy on adalimumab. A 43-year-old woman with severe Crohn's disease developed small painful erythematous ulcers on her buccal mucosa and lips, fever and right-sided facial palsy after 3 years of treatment with adalimumab (40 mg biweekly). She had recurrent herpes simplex infections of the mouth and she was diagnosed with Bell's palsy secondary to HSV. Adalimumab was stopped and valacyclovir 1000 mg tid was started for 7 days. Since she was already immunocompromised, she was not given corticosteroids. Her symptoms improved, and adalimumab was restarted a week after completion of valacyclovir. Four days after reinitiation of adalimumab, the patient's oral lesions and fever recurred and her facial palsy worsened. Valacyclovir was restarted, and her symptoms gradually resolved. Adalimumab was discontinued. This patient's Crohn's disease was subsequently managed surgically.
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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 | 0.007 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.003 | 0.002 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.010 | 0.007 |
| Insufficient payload (model declined to judge) | 0.003 | 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".