Safety of Injecting Insulin Through Clothes: A Case of <i>Mycobacterium immunogenum</i> Cutaneous Infection and Review of the Literature
Bibliographic record
Abstract
L.S., a 47-year-old white woman with type 1 diabetes, a bleeding diathesis, and iron deficiency anemia, was referred to an infectious diseases physician for assessment of a painful, nonhealing skin lesion. Before the referral, her primary care physician had treated her with several courses of oral antibiotics, including cephalexin, clindamycin, and amoxicillin, without improvement. She denied a history of preceding trauma, recent foreign travel, or exposure to aquatic animals or hot tubs. When questioned about whether the lesion was at the site of insulin injection, she stated this was possible because she had injected insulin at various locations through her clothes since adolescence, as instructed. On physical examination, the patient appeared well. Her skin examination was significant for a 5-cm erythematous, tender nodule on the anteromedial aspect of her right thigh (Figure 1). No drainage from the lesion or evidence of surrounding cellulitis was found. There was no associated lymphadenopathy, and the remainder of her physical examination was unremarkable. Routine laboratory tests, including leukocyte count with differential, platelets, electrolytes, creatinine, and liver enzymes, were within normal ranges. Her A1C was elevated at 10.8%. Histology of the biopsied lesion demonstrated nonspecific inflammation with negative stains for acid-fast bacilli (AFB) and fungi. Cultures, however, were positive for mycobacteria spp. after an extended incubation period of 63 days (compared to the conventional incubation period of 49 days). 16S rRNA sequencing identified the organism as Mycobacterium immunogenum . The antimicrobial agents the organism was susceptible to were limited to clarithromycin and tigecycline, with intermediate sensitivity to amikacin. The organism was resistant to ciprofloxacin, doxycycline, cefoxitin, imipenem, cotrimoxazole, and linezolid. 1. How did this …
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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 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.004 | 0.004 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.004 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 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".