Laryngeal Manifestation of Autoimmune Disease: Rheumatoid Arthritis Mimicking a Cartilaginous Neoplasm
Bibliographic record
Abstract
A 56-year-old male presented with acute airway obstruction. He reported rapid progression of dyspnea over the last few days since developing an upper respiratory infection. The patient had been followed by an otolaryngologist for slowly progressive dyspnea over a 1?-year period following an upper respiratory tract infection. Recently, while under treatment for “atypical” asthma, he had undergone a flexible bronchoscopy. A subglottic lesion was noted and biopsied. He reported dysphagia of solids and a recent 10-pound weight loss. He quit tobacco use 25 years earlier and had been treated 5 years previously with nonsteroidal anti-inflammatory drugs (NSAIDs) for arthritis. On examination, the patient demonstrated biphasic stridor, with suprasternal retractions. Flexible fiberoptic laryngoscopy revealed bilateral vocal fold immobility, with edematous vocal cords fixed in the midline. The glottic aperature was estimated to be 3 to 4 mm. The respiratory rate was 16 to 18 breaths per minute, and oxygen saturations remained above 95% on room air. The patient was administered a helium-oxygen mixture by mask and intravenous dexamethasone (10 mg every 8 hours) and was placed in a monitored setting. Within 24 hours, his symptoms improved. Laboratory investigations, including a complete blood cell count, differential white blood cell count, electrolyte levels, liver function tests, thyroid function test, blood cultures, and urine analysis, were unremarkable. Antineutrophilic cytoplasmic antibody and syphilis (Venereal Disease Research Laboratories) serologies were also negative. The erythrocyte sedimentation rate was elevated to 80 mm/h (normal < 20 mm/h). A computed tomographic (CT) scan of the neck (Figure 1) exhibited a soft tissue lesion involving the posterior region of the subglottis and contiguous circumferential thickening of the cricopharyngeus. The lesion appeared to be distinct from the thyroid gland. Barium swallow revealed no mucosal abnormalities. The patient was brought to the operating room for tracheostomy, panendoscopy, and biopsy. On laryngoscopy, a white, friable soft tissue lesion situated in the left posterior subglottis was biopsied. An interarytenoid band was noted and lysed. Both cricoarytenoid joints were immobile to palpation. A firm circumferential submucosal thickening of the cricopharyngeus made passage of a 10 mm esophagoscope difficult. The remainder of the esophagoscopy and bronchoscopy was normal. Multiple biopsies were taken of the subglottis and proximal esophageal mucosa. Pathologic examination of the subglottic lesion was reported as squamous mucosa with focal acute and severe chronic nonspecific inflammation of the stroma with significant eosinophilia. There was no evidence of malignancy, vasculitis, necrosis, or granuloma. Special stains were negative for microorganisms. Esophageal
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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) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 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".