Successful Lung Transplantation in a Case of Rapidly Progressive Interstitial Lung Disease Associated with Antimelanoma Differentiation-associated Gene 5 Antibodies
Bibliographic record
Abstract
Polymyositis (PM) and dermatomyositis (DM) are chronic autoimmune diseases characterized by skeletal muscle inflammation in which interstitial lung disease (ILD) is found in up to 78% of cases1. Clinically amyopathic DM, a subset of DM without objective muscle weakness, and positivity for antimelanoma differentiation-associated gene 5 autoantibodies (anti-MDA5) are known risk factors for rapidly progressive ILD (RPILD)2,3,4. We present a patient with DM, anti-MDA5 antibodies, and RPILD who successfully underwent a bilateral lung transplantation. This report was approved by the Regional Ethical Committee of Stockholm (2005/792-31/4 and 2011/1374-32). A 38-year-old white man presented with a 4-month history of uncharacteristic skin rash, mild muscle weakness, arthralgia, and exertional dyspnea. His physical examination revealed heliotrope rash, Gottron papules, periungual erythema, mechanic’s hands, small buccal mucosa erosions, fingertip ulcers, and muscle weakness. Cardiopulmonary auscultation was unremarkable. His complete blood count and muscle enzymes were normal. Erythrocyte sedimentation rate was > 90 mm/h, and C-reactive protein was 37 mg/l. He was positive for anti-Ro52 by Immunoblot, but the following were negative: anti-Mi2, anti-SRP, anti-Jo1, anti-PL7, anti-PL12, anti-dsDNA, anti-Sm, anti-Scl-70, anti-Scl-100, anti-SS/B, anti-RNP, rheumatoid factor, antinuclear antibody, and antineutrophil cytoplasmic antibodies. Muscle histopathology showed fiber size variation. A chest computer tomography (CT) showed unspecific basal reticular infiltrates. The patient was started on … Address correspondence to Dr. I.E. Lundberg, Rheumatology Unit, Karolinska University Hospital, Stockholm 17176, Sweden. E-mail: Ingrid.lundberg{at}ki.se.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 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 teacher head, 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".