Skeletal fluorosis after prolonged voriconazole therapy
Bibliographic record
Abstract
A 6-year-old girl underwent allogeneic hematopoietic stem cell transplantation for a relapsing acute myelogenous leukemia. She developed severe chronic graft-versus-host disease which required immunosuppressive therapies, including a prolonged course of high-dose steroids. She also presented a thrombotic microangiopathy complicated by renal failure requiring dialysis. Eleven months after transplantation, she was diagnosed with pulmonary and cerebral aspergillosis, prompting initiation of intravenous voriconazole. Unusually high doses were needed (11 mg/kg/dose every 8 hours) in order to achieve therapeutic plasmatic trough concentrations above 1 to 2 mg/L. After 2 months, she was transitioned to oral voriconazole at equivalent dosing. Six months after being on oral voriconazole, she complained of fatigue and diffuse musculoskeletal pain, initially attributed to her steroid treatment. Radiographs (Figure 1) of her femurs showed diffuse osteopenia and pronounced bilateral periosteal reactions with exostosis (arrows). ... The diagnosis of osseous fluorosis induced by prolonged voriconazole therapy was suspected and confirmed by a very high fluoride plasma concentration of 27.0 µmol/L (0.25 to 1.0 µmol/L). Her alkaline phosphatase level was also increased at 627 U/L (134 to 518 U/L), with a known normal baseline level preceding therapy. Voriconazole was discontinued and oral posaconazole was substituted in its place. Five months after voriconazole discontinuation, her musculoskeletal symptoms resolved and her fluoride plasma concentration decreased to 1.30 µg/mL.
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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 | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 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 | 0.000 |
| 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".