Severe, Reversible Dysphagia from Chloroquine and Hydroxychloroquine Myopathy
Bibliographic record
Abstract
Chloroquine and hydroxychloroquine are 4-aminoquinoline medications used in the treatment of malaria, amebiasis, connective tissue diseases, and skin disorders. 1A generalized toxic neuromyopathy can occur with their use.We report an 89year-old man with severe, relatively isolated and reversible dysphagia related to combined chloroquine and hydroxychloroquine myopathy.An 89-year-old man presented with a 3-year history of progressive oropharyngeal dysphagia with both solids and liquids.He had no fatigability of chewing or swallowing but had difficulty propelling the bolus back to his posterior pharynx.His dysphagia was profound, and he had lost over 20 pounds of weight.He twice developed aspiration pneumonia.He was otherwise in good health and had longstanding morphea profunda, a circumscribed, localized sclerosis of the skin and underlying soft tissues involving his chest, back, buttocks, and limbs.The morphea was diagnosed 18 years previously, and was successfully treated with hydroxychloroquine 200 mg twice daily by mouth for 18 years in addition to chloroquine 500 mg thrice weekly for the previous two years.He was not treated with cholesterol-lowering medications or other medications associated with myopathy.Swallowing studies demonstrated dysphagia and a cricopharyngeal bar.A cricopharyngeal myotomy was recommended by his local physicians.On flexible laryngoscopic assessment and review by an otolaryngologist, he had normal vocal cord motion, normal mucosa and no mass lesions.Poor tongue base propulsion and poor laryngeal elevation were found.On neurological examination, he had dysarthria and mild, symmetrical weakness involving the deltoids (4/5 MRC grading) and the neck flexors (4/5).He had focal weakness of the left toe extensors and the posterior and anterior tibialis from a prior L5 radiculopathy but otherwise no demonstrable diffuse or proximal lower extremity weakness.Motor strength in the face was normal with normal pharyngeal motion and no tongue atrophy or fasciculations.Muscle stretch reflexes were normal in the upper extremity and mildly reduced in the lower extremities with flexor plantar responses bilaterally.Sensation revealed only slight age-appropriate vibratory sensory deficit.Creatinine kinase (CK) was elevated at 557 units/litre (normal <336 U/l).Anti-acetylcholine receptor, anti-striated muscle antibody, β-hexosaminidase, serum protein electrophoresis and other basic laboratory studies were normal.Magnetic resonance
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
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 | 0.004 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.008 | 0.005 |
| 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".