Necrotizing Cutaneous Vasculitis in a Patient With Infective Endocarditis and Severe Rheumatoid Arthritis
Bibliographic record
Abstract
A 68-year-old woman with fever, chills, asthenia, night sweats, arthralgia, weight loss, and necrotizing skin ulcers on the body and lower extremities was admitted to our department. She had been followed for rheumatoid arthritis (RA) for over 20 years, and her rheumatoid factor (RF) level was very high at admission. A month ago, a temporary pacemaker was applied to the patient due to drug-induced bradyarrhytmia, but the pacemaker’s lead fractured and remained inside the right ventricle while it was removed. Revealing the vegetations on the fractured lead and tricuspid valve by echocardiography and methicillin- resistant coagulase-negative Staphylococcus aureus in separate blood cultures, the two major criteria for the diagnosis of infective endocarditis (IE) was confirmed to commence treatment of IE. The biopsy specimen from the skin ulcers revealed cutaneous vasculitis. Vasculitis is a serious complication of rheumatoid arthritis (RA) that develops in a minority of patients with this disease, and it is not uncommon in patients with IE. The diagnosis of rheumatoid vasculitis was confirmed by the history, clinical and laboratory findings of our patient. Methylprednisolon 500 mg intravenous bolus followed by 40 mg PO daily was administered. In spite of all taken measures the patient died of severe sepsis on the 50th day of her admission. In this case the differential diagnosis of cutaneous vasculitis in a patient with IE and severe RA is emphasized. doi:10.4021/jmc591w
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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) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| 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".