Renal Involvement in Antimyeloperoxidase Antineutrophil Cytoplasmic Antibody-positive Granulomatosis with Polyangiitis with Chronic Hypertrophic Pachymeningitis
Bibliographic record
Abstract
To the Editor: Granulomatosis with polyangiitis (GPA; formerly Wegener’s granulomatosis) is a small to medium-size vessel vasculitis involving various organs, with the classic triad of upper airway, lung, and kidney involvement. GPA can be accompanied by chronic hypertrophic pachymeningitis (CHP), characterized by inflammatory thickening of the cerebral or spinal dura mater1. Although the pathology of CHP does not depend on the contiguous spread of granulomatous lesions from the nasal or paranasal sinuses, GPA with CHP has been reported to present mostly with limited organ involvement2,3. Specifically, antimyeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA)-positive GPA with CHP has been reported to lack renal involvement1,2,4. We describe a case of MPO-ANCA-positive GPA, which presented with CHP-related central nervous system (CNS) symptoms and with renal abnormalities, with a discussion of the incidence of renal involvement in MPO-ANCA-positive GPA accompanied by CHP. A previously healthy 48-year-old Japanese man presented to the otolaryngology department with a 3-month history of fever, bilateral temporal headaches, left facial nerve paralysis, dysphagia, and hoarseness, which occurred sequentially. … Address correspondence to Dr. H. Kohsaka, Department of Medicine and Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima Bunkyo-ku, Tokyo 113-8519, Japan. E-mail: kohsaka.rheu{at}tmd.ac.jp
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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 | 0.005 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.006 | 0.004 |
| 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".