Graft Versus Host Diseases Presenting Endoscopically as a Tubular Structure Mimicking a Worm
Bibliographic record
Abstract
Graft Versus Host Diseases (GVHD) is the leading cause of morbidity and mortality after allogenic hematopoietic stem cell transplantation, occurring in up to 75% of patients [1]. According to the degree of involvement in each of the organ systems, acute GVHD can be clinically classified as grades I IV [2]. Colonoscopic examination can show diffuse edema, hyperemia, patchy erosion, scattered ulcer, sloughing and active bleeding [3, 4]. We report a case of a patient with GVHD that presented endoscopically as a tubular structure that looked like a dead worm. A 63 years old female patient with history of acute myelogenous leukemia underwent unrelated donor graft rejection followed by matched unrelated donor peripheral blood stem cell transplant presented with diarrhea. The patient underwent colonoscopy that showed mildly congested and erythematous colonic mucosa. Biopsy from the colon showed focal crypt abscess, apoptotic bodies, cryptal destruction and laminar propria fibrosis consistent with graft versus host disease grade 2. CT of the abdomen and pelvis was done and showed a bowel wall thickening due to edema involving multiple loops of jejunum, however the mucosa remained enhancing. The patient was diagnosed based on the clinical presentation with severe gut GVHD. Because the patient continued to have diarrhea and work up for infectious diarrhea was negative, a repeated colonoscopy was done and showed a granular mucosa with ulcerations involving the entire the colon. A tubular structure was seen floating in the colon and looked like a worm (Fig. 1). It was 30 cm in length with 0.7 cm in diameter. It was retrieved by the colonoscopy (Fig. 2). A cross sectioning revealed fibrous tissue bands surrounded by clotted and hemorrhagic tissue. The colonic biopsy showed GVHD. The histopathological examination of the tubular structure was consistent with fibrinopurlent exudate. We concluded that the tubular structure represented a sloughed gut tissue induced by severe gut GVHD.
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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 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.002 | 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".