A Case of Infective Endocarditis Caused by <i>C. Hominis</i> in a Patient with HLAB27 Aortitis
Bibliographic record
Abstract
A 59-year-old, right handed, Caucasian engineer presented to the emergency department 12 hours after the sudden onset of left sided weakness and numbness.The patient had been in good health until the year prior to admission.He had an episode of bilateral ankle swelling with cough, pleuritic chest pain and night sweats 12 months prior to admission.Six months later he had left ankle swelling and left foot drop, followed by right knee soreness and swelling a month later, and swelling of the left calf and right foot two months after that.He gave an eleven month history of migrating arthralgias, myalgias and periodic lower back pain.The episodes of myalgia and arthralgia typically lasted three to ten days.The patient reported some symptomatic relief with ibuprofen.He was fatigued throughout this period.There was no history of shoulder or hip pain, conjunctivitis, rash, photosensitivity, gastrointestinal or genitourinary complaints.X-rays of the sacro-iliac joints were normal.He had developed moderate hypertension in the year prior to admission.There was no history of dental work, or dental carries.His family history was unremarkable.Abdominal ultrasounds documented splenomegaly increasing from 13 cm to 18 cm in the year prior to admission.ESR was consistently elevated-ranging between 45 and 85 mm/hr.He had a normocytic anemia.Genetic testing revealed an HLA B27 genotype.Subsequently the patient was diagnosed with HLA B27 associated reactive arthritis.He developed a new cardiac murmur.A transthoracic echocardiogram performed a month before admission revealed 3+ aortic regurgitation, a mildly dilated left ventricle with normal left ventricular ejection fraction, and 1+ mitral regurgitation with a normal valve.A TTE performed four years earlier had been normal.The aortic insufficiency was deemed consistent with HLA B27 associated aortitis and a TEE was scheduled to rule out further valvular disease.The patient presented with acute stroke prior to his scheduled outpatient TEE.On presentation he was alert and oriented.His blood pressure was 164/84.He had a low grade fever.His respiratory rate was 16 and pulse was regular at 88.He had a water hammer pulse with a JVP 5cm above the sternal angle with a bifid contour.The apex was 15 mm in diameter and hyperdynamic.A systolic ejection click was audible at the left upper sternal border.A grade II/VI systolic crescendo-decrescendo murmur was audible at the apex and an Austin Flint rumble was present.The spleen was palpable.There was no lymphadenopathy.Skin, nails and joints were unremarkable.There was no peripheral edema.He had mild dysarthria and a left upper motor neuron facial paresis, left hemiparesis and dense left sensory loss.The left plantar response was extensor.
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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 | 0.002 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.004 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.004 | 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".