Chorea as the Presenting Clinical Feature of Primary Antiphospholipid Syndrome in Childhood
Bibliographic record
Abstract
Sir, We read with interest the article by Kiechl-Kohlendorfer et al [[ 6 ]] reporting on 3 children with chorea as the presenting feature of primary antiphospholipid syndrome (PAPS). We find it difficult to exclude the possibility of acute rheumatic fever (ARF) as the cause of chorea in these patients for the following reasons: One of the common causes of chorea in childhood is Sydenham chorea related to rheumatic fever [2, 8]. Figueroa et al [5] reported that 80 % of patients were positive for anticardiolipin (aCL) during the acute episode of rheumatic fever versus 40 % when the disease was inactive. The frequency of aCL antibodies was the same in patients whether or not they had chorea. Although Narin et al [7] failed to reproduce these findings, they too had some patients who they felt had ARF and who had high aCL antibody levels. Antiphospholipid antibodies are not specific to PAPS syndrome and can be detected in a wide variety of infectious, neoplastic, inflammatory and autoimmune diseases [1]. Streptococcal antibody titers may be normal at the time of presentation of isolated Sydenham chorea, because of the long latency between acute group A streptococcal infection and the clinical onset of chorea [3]. Therefore a negative ASOT does not rule out ARF as the cause of chorea. For these reasons, we would counsel strongly against denying a child with possible Sydenham chorea who is aCL-positive appropriate antibiotic prophylaxis [[ 4 ]] unless she/he has other classical features of PAPS.
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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 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| 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 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 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".