S3715 A Possible Case of Granulomatous Gastritis Linked to Carbon Tetrachloride Exposure
Bibliographic record
Abstract
Introduction: Granulomatous gastritis (GG) is a rare clinical entity, and most cases described in the literature are associated with Crohn’s disease, infections, or underlying malignancy. Idiopathic GG is much less common, and the use of volatile solvents as an etiology has not been previously described. We present a possible case of granulomatous gastritis linked to occupational exposure to carbon tetrachloride. Case Description/Methods: A 67 year-old male underwent endoscopy for long-standing reflux symptoms and abdominal discomfort, not responsive to daily proton pump inhibitor (PPI) therapy. Index endoscopy revealed antral erythema and biopsies revealed florid non-caseating granulomatous gastritis. Work-up for infectious etiologies, sarcoidosis and Crohn’s all returned back negative, including normal imaging, endoscopy, and histological stains. The patient was diagnosed with idiopathic granulomatous gastritis. Multiple repeat upper endoscopies with biopsy showed persistent GG in the absence of infections. Occupational exposure to carbon tetrachloride was identified in the patient’s history, with frequent use over a one-year period while working on an industrial ship. Carbon tetrachloride has been demonstrated in the literature to cause hepatic toxicity, with one mechanism being through granuloma formation. Discussion: Our patient achieved symptom control through dose escalation to twice-daily PPI therapy. One possible etiology identified was this patient’s exposure to carbon tetrachloride, a solvent used in the past as a cleaning agent, which is how our patient had his prolonged exposure. Limited data suggest that dermal exposure of carbon tetrachloride can cause gastrointestinal symptoms such as nausea and vomiting, though the clear mechanism behind that is unclear. Perhaps the most well-known toxicity of carbon tetrachloride is hepatotoxicity, with one mechanism being granuloma formation seen in studies of mice who were injected with the substance. Although a definitive causality cannot be proven, we propose a potential etiology behind our patient’s diagnosis of granulomatous gastritis.
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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) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.008 | 0.003 |
| Insufficient payload (model declined to judge) | 0.006 | 0.002 |
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".