A207 SCLEROSING CHOLANGITIS SECONDARY TO DISSEMINATED VARICELLA ZOSTER VIRUS: A CASE REPORT
Bibliographic record
Abstract
Sclerosing cholangitis represents a spectrum of chronic and progressive diseases of the intrahepatic and extrahepatic biliary ducts. The condition is characterized by multifocal inflammation, fibrosis, and stricturing, resulting in biliary cirrhosis and eventual hepatic failure. While PSC accounts for the majority of cases, a small proportion can arise secondary to known causes including biliary surgery, obstruction, malignancy, bacterial cholangitis, trauma, ischemia, and infiltrative diseases. Here we present a case of sclerosing cholangitis secondary to disseminated Varicella Zoster Virus. A 70-year old female on Rituximab therapy for follicular lymphoma presented with abdominal pain, anorexia and a diffuse vesicular rash. EGD revealed severe esophagitis and a large, erosive mass in the fundus of the stomach. PCR studies of the skin and gastric mucosa confirmed the presence of disseminated Varicella Zoster Virus, which was treated with IV acyclovir. The patient presented soon after discharge with new symptoms of pruritus and fatigue, with elevated cholestatic liver enzymes. MRCP revealed multifocal strictures throughout the intrahepatic bile ducts with mild extrahepatic duct involvement. Liver biopsy was suggestive of a cholangiopathy of uncertain etiology without the classic “onion skin” pattern of PSC. Biopsies were negative for malignancy, and for viral PCR and immune serologic tests, including for autoimmune cholangiopathy. The patient showed improvement in both her symptoms and liver enzymes and repeat liver biopsy and MRCP confirmed stable disease. An endoscopic ultrasound revealed the presence of multifocal stricturing of the pancreatic duct with a normal common bile duct free of stones or sludge and normal pancreatic parenchyma. The diagnosis of disseminated VZV with GI involvement, and strong temporal relationship between the appearance of biliary disease and VZV infection suggest a VZV-induced SSC. The patient showed symptomatic and biochemical improvement following treatment with acyclovir. There are many features of this presentation including the patient’s age, gender, rapid onset, and clinical improvement, which are very atypical for PSC. The patient does not have a history of inflammatory bowel disease and all autoimmune markers are negative. The pancreatic duct strictures are suggestive of a secondary cause affecting both the hepatic bile ducts and pancreatic duct. There was no evidence to suggest that another known secondary cause could have contributed to this patient’s presentation. Serial liver biopsies were repeatedly negative for lymphoma. Obstructive and ischemic causes of SSC were ruled out via ERCP and MRCP. In this case the most likely etiology of the sclerosing cholangitis is the disseminated VZV. This is the first reported case of VZV-induced SSC. None
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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 | 0.003 |
| Meta-epidemiology (narrow) | 0.004 | 0.002 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.005 | 0.003 |
| Science and technology studies | 0.005 | 0.002 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.007 | 0.003 |
| Insufficient payload (model declined to judge) | 0.004 | 0.002 |
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".