Severe Takayasu Arteritis Complicated by Mesenteric Ischemia
Bibliographic record
Abstract
Takayasu arteritis (TA) is an idiopathic large vessel vasculitis which occurs mostly in young Asian females. The authors report an atypical presentation of TA in a woman who presented with signs and symptoms of limb claudication and mesenteric ischemia. This case illustrates the potential severity of this disease and the difficulty in its diagnosis and treatment. A 46-year-old Caucasian woman was admitted to the hospital with right lower limb claudication, aroused for small distances, in association to ischemic ipsilateral foot ulcers. She also reported recurrent episodes of abdominal pain, vomiting and diarrhea which leaded to an overall weight loss of 10 kg in a period of a year. Non-invasive vascular testing revealed a right ankle-brachial index of 0.17 and a left ankle-brachial index of 0.37. The abdominal aortography and the computed tomography (CT) angiography showed an occlusion of the superior mesenteric artery and irregularities of the aortic lumen. Oclusions in the right internal iliac artery and in the distal common femoral artery were found in the pelvic aortography. Lower limbs arteriography revealed multiple stenoses. The histological result from the femoral endarterectomy was consistent with large vessel vasculitis. The diagnosis of TA was established according to the American College of Rheumatology Criteria, based on the patient’s symptoms, physical and imaging findings. Despite aggressive immunosuppressive therapy with prednisolone and infliximab, an atypical refractory massive mesenteric ischemia occurred, leading to patient’s death. TA is a rare disease with variable presentation. Since this disease is associated with high morbidity and mortality, an early diagnosis is essential for the best prognosis. Critical mesenteric ischemia and peripheral limb ulcers are rare presentations. As mesenteric ischemia can be potentially fatal, early aggressive immunosuppressive therapy and resection of the affected bowel segment are usually required. J Med Cases. 2017;8(12):383-387 doi: https://doi.org/10.14740/jmc2945w
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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 | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
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".