A case of herpes zoster masquerading as stereotactic body radiation therapy associated chest wall pain in a patient treated for primary non-small cell lung cancer
Bibliographic record
Abstract
Introduction: Lung cancer is the leading cause of cancer-related death in the United States. In patients with Stage I non-small cell lung cancer (NSCLC) deemed medically inoperable due to comorbities, stereotactic body radiation therapy (SBRT) is the standard of care. We are reporting a case of a medically inoperable patient with Stage I NSCLC who received SBRT to the lung. The patient presented herpes zoster masquerading as radiation-related chest wall pain. Presentation: The patient was a 76-year-old Caucasian female with a 40-pack year history of tobacco who presented with a solitary pulmonary nodule on chest x-ray during a COPD exacerbation. Workup revealed squamous cell carcinoma, and the patient was determined to be medically inoperable due to poor lung function secondary to COPD. Nine months after completion of SBRT, the patient presented with chest wall pain that evolved into herpes zoster along the T4 dermatome. Conclusion: We are presenting a case SBRT-related herpes zoster. While chest wall pain is a common side effect of this treatment, herpes zoster has not been previously reported. Because shingles most commonly presents as a pain episode before rash eruption, it can be easily mistaken for chest wall pain alone. Shingles can be treated effectively with anti-viral medications and anti-inflammatory agents. Thus, it is important to keep this side effect in mind for patients who receive SBRT to the lung and follow-up with chest wall pain.
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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 | 0.003 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.006 | 0.004 |
| 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".