Jejunal mucormycosis in a patient with refractory AML
Bibliographic record
Abstract
Jejunal mucormycosis in a patient with refractory AMLSamuel De l’Etoile-Morel, MD. McGill University Health Centre. Department of Medicine, Division of Infectious Diseases. 1001 Decarie Blvd, Montreal, Quebec H4A 3J1 Room E05.1811.2.Vladimir Sapon-Cousineau, MD. Department of Medicine, Division of Hematology. 1001 Decarie Blvd, Montreal, Quebec H4A 3J1 Room D02.7731.Dan L. Deckelbaum, MD. McGill University Health Centre. Department of Surgery, Divisions of Trauma and General Surgery. 1650 Cedar Ave, Montreal, Quebec H3G 1A4. L9 425.Michael Sebag, MD McGill University Health Centre. Department of Medicine, Division of Hematology. 1001 Decarie Blvd, Montreal, Quebec H4A 3J1 Room D02.7515.Zu-hua Gao, MD McGill University Health Centre. Department of Clinical Laboratory Medicine, Division of Pathology. 1001 Decarie Blvd, Montreal, Quebec H4A 3J1 Room E04.1820.Vivian G. Loo, MD McGill University Health Centre. Department of Medicine, Division of Infectious Diseases. 1001 Decarie Blvd, Montreal, Quebec H4A 3J1 Room E05.1824.Corresponding author : Samuel De l’Etoile-Morel, MD. McGill University Health Centre. Department of Medicine, Division of Infectious Diseases. 1001 Decarie Blvd, Montreal, Quebec H4A 3J1 Room E05.1811.2. Telephone 514-934-1934 extension 53333 samuel.deletoile-morel@mail.mcgill.caA 47-year-old man received chemotherapy for the treatment of refractory acute myeloid leukemia. Two weeks after re-induction, he developed fever, neutropenia, nausea and severe vomiting with abdominal pain. Computed tomography of the abdomen showed a small bowel obstruction with ischemic changes of the jejunum concerning for mesenteric ischemia (panel A). An urgent open laparotomy was performed revealing two areas of jejunal necrosis (panel B) and the patient underwent a partial small bowel resection with primary anastomosis.Histopathological examination of the jejunum with Grocott staining demonstrated ischemic necrosis associated with angioinvasive zygomycosis (panel C). Rhizopus oryzae was identified as the causative pathogen using polymerase chain reaction followed by DNA sequence analysis on the pathology specimen.The patient was treated intravenously with liposomal amphotericin and subsequently transitioned to oral isavuconazole. He was subsequently discharged from the hospital and died approximately 1 year later of progressive AML.Gastrointestinal mucormycosis remains a rare infection among immunocompromised hosts and a high index of suspicion is imperative (1). Its presentation can mimic ischemic colitis often resulting in a diagnosis made by pathology and not by conventional culture. Successful management includes early surgical resection and initiation of appropriate antifungal therapy.1. Spellberg B. Gastrointestinal mucormycosis: an evolving disease. Gastroenterol Hepatol (N Y). 2012;8(2):140-2.
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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 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.004 | 0.003 |
| 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".