Hydroxycarbamide‐related cutaneous ulcer complicated by osteomyelitis
Bibliographic record
Abstract
A 78-year-old male with a history of polycythemia vera (PV) presented with bilateral foot ulcerations (a) limiting his ability to exercise or wear shoes. His PV had been managed for the previous 5 years with aspirin 81 mg per os (PO) daily, intermittent phlebotomy, and hydroxycarbamide (hydroxyurea [HU]) 1500 mg PO daily. At the time of presentation, his hemoglobin was 138 g/L, hematocrit 0.41, white blood cell count 14.5 × 109/L, and platelet count 695 × 1012/L. Cultures from the right toe ulcer grew Pseudomonas aeruginosa and Streptococcus pyogenes; scintigraphy bone scan demonstrated evidence of osteomyelitis of the right first phalanx. The HU was held and the patient was started on a 6-week course of ciprofloxacin and doxycycline. Ruxolitinib 10 mg PO BID was initiated for management of PV. Follow-up 3 months later demonstrated significant improvement of the cutaneous ulcerations (b). Cutaneous toxicity can occur in 5%–12.5% of myeloproliferative neoplasm patients treated with HU, and can lead to significant complications such as the secondary osteomyelitis seen in this case. Etiology of ulcers is multifactorial with microvascular disturbance from reduced red blood cell deformability and reduced wound healing due to cytotoxic effects on keratinocytes and basal cells of the epidermis and endothelium. European Leukemia NET (ELN) criteria for HU intolerance includes development of lower extremity ulcers and should prompt the use of alternative cytoreductive therapy. Patient counselling and clinician recognition of HU cutaneous adverse events may allow for rapid therapy change and prevention of complications. Patient provided written consent for photographs to be used for publication and education purposes. Data sharing is not applicable to this article as no new data were created or analyzed in this study.
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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) | 0.003 | 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; both teacher heads agree on what is shown here.
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".