IgG4 Syndrome Presenting as Leptomeningitis in a Young Woman
Bibliographic record
Abstract
To the Editor: Immunoglobulin G4-related disease (IgG4-RD) is a recognized systemic condition that can affect almost every organ system1. The most commonly involved organs are the pancreas, salivary glands, and biliary tree. The common presentation with central nervous system (CNS) involvement is hypophysitis and pachymeningitis, but rarely leptomeningitis2. Only 3 reported cases of leptomeningitis have been reported, all of them presenting as cognitive decline, and 2 associated with rheumatoid arthritis (RA)3. We describe a patient with unilateral hearing loss and a right frontal mass on magnetic resonance imaging (MRI) who was subsequently diagnosed with IgG4-related leptomeningitis after biopsy. This is a unique case of IgG4-related leptomeningitis because of its presentation and lack of association with RA or positive serological markers. A 43-year-old woman with thyroid follicular cancer, post-thyroidectomy, had progressive right-side hearing loss for 2 months. She was also noted to have gait difficulty, pins-and-needles sensations in the feet, and facial droop on the left side. Physical examination showed that she was alert and oriented to time, place, and person. Her cranial nerves were intact except … Address correspondence to Dr. S. Medavaram, 3111 Bristol Station Court, Carteret, New Jersey 07008, USA. E-mail: sowmini.medavaram{at}gmail.com
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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 | 0.004 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.006 | 0.003 |
| 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".