Cytomegalovirus-induced Colon Perforation in Systemic Lupus Erythematosus
Bibliographic record
Abstract
To the Editor: Acute abdomen has been reported in 10% of patients with systemic lupus erythematosus (SLE)1. The differential diagnoses of abdominal pain in SLE do not differ significantly from those in patients without SLE with the exception of serositis, thrombotic, or hemorrhagic events associated with antiphospholipid antibodies, mesenteric vasculitis (MV), and cytomegalovirus (CMV) infection. The distinction between MV and CMV infection is critical because both are life-threatening disorders requiring radically different therapeutic approaches. We describe the case of a patient with SLE who was profoundly immunosuppressed and who presented with an acute surgical abdomen secondary to a colonic perforation, and emphasize the relevance of considering a viral etiology in this setting. A 54-year-old woman with a 22-year history of SLE presented to the Emergency Department with acute abdominal pain. Previous manifestations of her disease included serositis, arthritis, nephritis, and cytopenias. In 2001, the patient received induction (cyclophosphamide) and maintenance [azathioprine (AZA)] therapy for class IV lupus nephritis (National Institutes of Health criteria activity index 5, chronicity index 8). Optimization of the AZA dose was limited because of myelosuppression. Over the previous 8 months, her creatinine … Address correspondence to Dr. I. Colmegna, Division of Rheumatology, Department of Medicine, McGill University Health Centre, Royal Victoria Hospital, 1001 Décarie Blvd., Bloc E, M2-3238, Montréal, Québec H4A 3J1, Canada. E-mail: ines.colmegna{at}mcgill.ca
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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 | 0.006 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.007 | 0.003 |
| Insufficient payload (model declined to judge) | 0.003 | 0.002 |
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".