Acute Acalculous Cholecystitis: A Rare Presentation of Autoimmune Hepatitis and Primary Sclerosing Cholangitis Overlap Syndrome
Bibliographic record
Abstract
Lymphoplasmacytic cholecystitis (LPC) is a unique form of chronic cholecystitis, and it has been reported in patients with medical conditions such as primary sclerosing cholangitis, inflammatory bowel disease, and autoimmune pancreatitis. We report a case of LPC in a 23-year-old male with a history of autoimmune hepatitis who presented to the hospital with 3-day duration of abdominal pain, nausea and vomiting. A clinical diagnosis of acute cholecystitis and sclerosing cholangitis was made, and the patient was treated with laparoscopic cholecystectomy. Histopathological examination of the gallbladder revealed marked diffuse mononuclear inflammatory infiltrate that was rich in IgG4-positive plasma cells and focal neutrophilic inflammation with erosion. These findings were consistent with active LPC. The patient’s post-operative endoscopic retrograde cholangiopancreatography performed 1 month after cholecystectomy revealed typical features of primary sclerosing cholangitis. This is the first report of acute acalculous cholecystitis as an initial presentation of autoimmune hepatitis and primary sclerosing cholangitis overlap syndrome. J Med Cases. 2018;9(10):332-337 doi: https://doi.org/10.14740/jmc3137w
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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 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.003 | 0.001 |
| 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".