Immune Thrombocytopenic Purpura Secondary to Histoplasmosis
Bibliographic record
Abstract
Immune thrombocytopenic purpura (ITP) is a relatively common acquired bleeding disorder characterized by autoimmune destruction of platelets. In adults, the annual incidence is around 1.6/100,000, common in middle aged females. In patients with ITP, physical examination is usually normal aside from bleeding manifestations, such as petechiae, ecchymoses, and purpura. The three key diagnostic criteria for ITP are isolated thrombocytopenia with otherwise normal peripheral complete blood count and smear, an absence of hepatosplenomegaly and lymphadenopathy on physical examination, and platelet response to classic ITP therapy. Review of the literature has shown case reports of disseminated histoplasmosis presenting with thrombocytopenia. Our patient comes from a geographic location where histoplasmosis is endemic. Most cases of histoplasmosis have mild symptoms and usually escape diagnosis. The microconidia formed in the mold phase of Histoplasma capsulatum are easily aerosolized, inhaled into the lungs, and then phagocytized by alveolar macrophages. Inside the macrophage, the organism converts to the yeast phase, survives within the macrophage for the first few weeks, and disseminates widely throughout the reticuloendothelial system. If cell-mediated immunity is deficient because of immunosuppression due to corticosteroids, transplanted organs, the organisms remain viable within macrophages and cause progressive infection. Most patients have either no symptoms or mild pulmonary complaints that are not severe enough to seek medical care. Although disseminated histoplasmosis has been reported to be associated with thrombocytopenia and anemia, most of these patients are immunocompromised. We report a case of ITP secondary to histoplasmosis in an immunocompetent patient. J Med Cases. 2015;6(11):483-484 doi: http://dx.doi.org/10.14740/jmc2230w
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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 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 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".