Managing a Patient Presenting With Chest Pain and Gastrointestinal Complaints Using Dupilumab
Bibliographic record
Abstract
Adverse drug reactions or adverse drug events account for a significant proportion of emergency department visits among children and adolescents. Unfortunately, rare reactions to medications may go unnoticed by clinicians due to a lack of reporting to drug surveillance and monitoring programs. We present the case of an 18-year-old male who visited the emergency department on two separate occasions after receiving dupilumab injections for his atopic dermatitis. Ten days prior to his presentation, he was evaluated in the emergency room for the onset of chest pain, five days following his first dupilumab injection. Investigations in the interim revealed no cardiac pathology. He presented with a complaint of severe abdominal pain associated with nausea and vomiting several hours after receiving his second dupilumab injection. Investigations for causes of acute gastrointestinal or anaphylactic reactions only revealed mild leukocytosis and hypokalemia. A definitive diagnosis of hypersensitivity reaction, such as anaphylaxis or serum-sickness-like reaction, could not be made at either emergency visit due to the lack of objective findings and few similar reported cases. However, the timing of each event made an adverse reaction highly suspicious as the inciting factor of this patient's symptoms. He received oral potassium, ketorolac, and ondansetron for headache and ongoing nausea respectively. He was discharged home within a few hours after his symptoms had resolved. The limited reports and evidence of these symptoms being associated with dupilumab injections made it difficult to reach a definitive diagnosis. However, a holistic review of the patient's history, medication list, and contextual factors revealed that a rare adverse drug reaction was a possible inciting factor on each separate occasion. Further research is required to determine the frequency and explore the existence of any causal relationship between dupilumab treatment and chest pain or gastritis in adolescent populations.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
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 teacher head, 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".