Scurvy as the Presenting Illness of Whipple’s Disease Exacerbated by Treatment with Etanercept in a Patient with Ankylosing Spondylitis
Bibliographic record
Abstract
To the Editor: A 35-year-old man was diagnosed with ankylosing spondylitis (AS) in 2004. HLA-B27 typing was negative. He started therapy with etanercept 25 mg twice weekly subcutaneously in September 2008 because of highly active disease. Two months after starting etanercept, the condition was not improved. He was hospitalized because of sudden onset of a gingival nodule (Figure 1A), and purpura (Figure 1B), and a history of abdominal pain with 3 non-bloody stools per day, fatigue, early satiety, and a 6 kg weight loss during the preceding 4 months. Etanercept was then stopped. Figure 1. Clinical cutaneous manifestations associated with vitamin C deficiency before treatment (A, B) and reduction of these manifestations after 10 days of treatment (C, D). On examination at our institution, his temperature was 37.5°C, blood pressure 120/80 mm Hg, pulse 88 beats per minute, and weight 66 kg. The spleen edge was palpable 2 cm below the costovertebral margin. He had lower limb purpura, lower limb edema, and gingivitis. Results of abdominal and neurological examination were normal. Laboratory studies showed erythrocyte sedimentation rate (ESR) 82 … Address correspondence to Dr. Hmamouchi; E-mail: i.hmamouchi{at}yahoo.fr
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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 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 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 | 0.004 | 0.003 |
| 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".