Perianal Crohn Disease after Treatment with Rituximab for Active Granulomatosis with Polyangiitis
Bibliographic record
Abstract
To the Editor: Rituximab (RTX) in combination with glucocorticoids has been recommended for relapsing granulomatosis with polyangiitis (GPA) if the disease remains active after a course of cyclophosphamide (CYC) lasting 3–6 months1. We describe a case of perianal Crohn disease (CD) in a patient with GPA who had been treated with RTX. A 24-year-old woman with GPA was diagnosed in 2006 with bilateral cavitating pulmonary lesions on computed tomography, pauciimmune glomerulonephritis with crescents and extraglomerular arteritis on renal biopsy, mononeuritis multiplex, and proteinase 3 (PR3)-antineutrophil cytoplasmic antibodies (ANCA) of > 100 U/ml. Six pulses of CYC with methylprednisolone were administered in 2006, but the patient experienced pulmonary and uveal recurrence of her GPA 5 weeks later. She had 1 course of 2 infusions of RTX (1 g per infusion) in combination with CYC in November 2006 (total cumulative CYC dose 7.5 g). In 2008 she developed headaches secondary to GPA recurrence affecting the pituitary gland confirmed by transsphenoidal biopsy and resulting in … Address correspondence to Dr. S. Boyle, Rheumatology Department, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK. E-mail: boyledoc{at}yahoo.co.uk
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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 | 0.002 | 0.010 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.000 |
| Research integrity | 0.007 | 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".