Rare Cause of Severe Neurological Impairment in a Young Patient With Lupus
Bibliographic record
Abstract
Systemic lupus erythematous (SLE) is a chronic autoimmune disease that frequently leads to kidney involvement. Hypertension in lupus nephritis (LN) is common, but malignant hypertension (MH) is a rare condition. MH in LN is associated with severe clinical manifestations and intrarenal vascular lesions. A 19-year-old woman with a history of SLE, class VI LN and MH presented with sudden drop in general status, confusion, diplopia, bradypsychia, and bradylalia. Physical exam showed cold extremities, cyanosis, high blood pressure (260/100 mm Hg) and tachycardia. Neurological exam showed impairment of the cerebellum, left central facial palsy and left-sided hemiparesis. Laboratory work showed thrombocytopenia, hyperuricemia, hypoalbuminemia and an estimated glomerular filtration rate of 66.1 mL/min/1.73 m 2 . A cerebral computed tomography (CT) showed no hemorrhagic lesions, but a diffuse hypodense edematous area in the pons, midbrain and bilateral thalamic nuclei. She was started on antihypertensive therapy, dexamethasone and mannitol. After 5 days in intensive care unit, a brain magnetic resonance angiogram (MRA) showed petechial hemorrhage and swelling in deep thalamic regions, left internal capsule, pons, and midbrain. Nimodipine was added to the regimen. Workup for JC virus and Listeria monocytogenes was negative. Evolution was favorable with complete remission of neurological symptoms. Repeated brain MRA confirmed regression of swelling and hemorrhagic lesions. The diagnosis of hypertensive encephalopathy was sustained by improved clinical evolution under anti-edema measures, antihypertensives and by CT/magnetic resonance imaging (MRI). Differential diagnosis was made with central nervous system vasculitis and infections due to immunosuppression therapy (tuberculosis, HIV, and JC virus). This case describes the evolution of a young woman with lupus and recurrent MH, complicated with neurological manifestations. J Med Cases. 2016;7(11):488-490 doi: http://dx.doi.org/10.14740/jmc2676w
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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 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 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".