Echinococcus Presenting as Painless Jaundice
Bibliographic record
Abstract
A previously well, 24-year-old male resident of Vancouver, British Columbia, presented to the emergency department with a twomonth history of gradual onset of painless jaundice, dark urine and pale stool.At the time of presentation, he experienced a dramatic rise in the levels of the following liver enzymes: alkaline aminotransferase 272 U/L; alanine aminotransferase 244 U/L; gamma-glutamyl transferase 487 U/L; and alkaline phosphatase 1085 U/L, with an international normalized ratio of 1.0 and an albumin level of 39 g/L.His serum bilirubin level was highly elevated (367 μmol/L) with a conjugated fraction of 282 μmol/L.Hepatitis was the presumptive diagnosis based on positive serology for hepatitis A. However, a computed tomography scan of the abdomen revealed a complex, cystic mass 10.9 cm × 17.9 cm in size in the epigastric region with rim calcifications (Figure 1).This was concerning for a malignant or infective process and the patient was referred to the hepatobiliary surgery service.The patient experienced no fever, cough, nausea, vomiting or abdominal pain.He had no known contacts with similar symptoms.He had travelled to Belgium, but had not travelled to the tropics or Northern Canada.There was no known exposure to animals, including canines.He underwent an endoscopic retrograde cholangiopancreatography with placement of bilateral biliary stents and ultrasound-guided percutaneous drainage of the hepatic abscess.The subsequent culture of the abscess fluid grew Candida albicans, which was treated with fluconazole.The patient became febrile and his jaundice did not improve and, thus, a right hepatectomy and cholecystectomy was performed.The surgical specimen contained a complex hydatid cyst 12 cm in diameter (Figure 2).There were numerous hyalinized profiles in the cyst wall consistent with daughter cysts (Figure 3).The final histological diagnosis was echinococcus with features suggestive of Echinococcus multilocularis.The patient was treated postoperatively with albendazole, 400mg/day orally.Subsequent serology was positive for serum immunoglobulin G antibodies to echinococcus confirmed by immunoblot.He remains asymptomatic without evidence of recurrence and his liver enzyme levels have normalized.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
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) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| 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".