A Fatal Case of Calciphylaxis in a Patient with Systemic Lupus Erythematosus and Normal Renal Function
Bibliographic record
Abstract
To the Editor: Calciphylaxis is a rare condition that involves cutaneous microvascular calcification leading to thrombosis and occlusion. Initial lesions appear violaceous and progress to non-healing necrotic ulcerations1. One-year mortality is over 50%, with sepsis as the leading cause of death1. Calciphylaxis is well described in patients with endstage renal disease with abnormalities in the calcium-phosphate-parathyroid hormone (PTH) axis2. An increasing number of case reports describe calciphylaxis in the absence of renal impairment associated with connective tissue disease, primary hyperparathyroidism, malignancy, liver disease, and protein C or S deficiencies3. We describe a case of rapidly progressive nonuremic calciphylaxis in a patient with systemic lupus erythematosus (SLE) and highlight the importance of calciphylaxis in the differential diagnosis of cutaneous ulceration. Our patient was a 77-year-old white woman with a 20-year history of SLE with features of arthritis, positive antinuclear antibody (ANA), hypocomplementemia, pulmonary involvement, and Raynaud disease. Her immunosuppressive regimen included azathioprine and hydroxychloroquine. Her comorbidities included type II diabetes, recurrent venous thromboembolism treated with warfarin for over 10 years, coronary artery disease, pulmonary … Address correspondence to Dr. L.J. Albert, Division of Rheumatology, Department of Medicine, Toronto Western Hospital, 399 Bathurst St., 1E – 424, Toronto, Ontario M5T 2S8, Canada. E-mail: lori.albert{at}uhn.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 | 0.001 | 0.007 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.003 | 0.002 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.010 | 0.006 |
| 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".