S4096 Don’t Let Tropical Sprue Fool You
Bibliographic record
Abstract
Introduction: Malabsorption syndrome may lead to serious complications, including a weak immune system and failure to thrive. A rare cause of such disorders, tropical sprue (TS), poses diagnostic challenge in areas prone to celiac disease due to similar symptoms and histologic findings. We present this case of a Canadian visitor whose health deteriorated in Islamabad to highlight the importance of keeping tropical sprue in mind when considering celiac disease (CD). Case Description/Methods: A 24-year-old man presented with 3 months of persistent loose stools, vomiting and 40 kg weight loss. He presented hypotensive with pale, dry scaly skin, and a benign abdominal exam. Labs revealed megaloblastic anemia, abdominal ultrasound showed biliary sludge, and CT scan was unremarkable. An upper-GI endoscopy demonstrated villous blunting and intraepithelial lymphocytes consistent with Marsh category type 3A and a diagnosis of celiac disease. Three weeks later, he presented with severe lethargy and immobility. At this time the patient was diagnosed with tropical sprue after a repeat endoscopy yielded a similar microscopic picture and negative serological and genetic testing for gluten enteropathy. After treatment with tetracycline and folate replacement, his symptoms improved (Figure 1). Discussion: While the etiology of tropical sprue is not well understood, an intestinal infection is suspected to be an inciting factor leading to mucosal injury, delayed intestinal transit, and bacterial overgrowth. The incidence in North America is 1% and 8% in tropical regions. Despite its prevalence in Pakistan, this case presented a diagnostic challenge due to its overlapping features with CD. The presence of ileum involvement with megaloblastic anemia, only partially blunted villi, intraepithelial eosinophils, and radiologically thickened folds in the jejunum, are all suggestive of TS. However, diagnosis of tropical sprue can only be made by ruling out CD with negative gluten enteropathy serological testing. Tetracyclines and vitamin replacement can result in symptom improvement and resolution. While tropical sprue can be difficult to diagnose, thorough laboratory and endoscopic evaluations can yield the correct diagnosis and decrease morbidity.Figure 1.: Biopsy report.
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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 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.004 | 0.004 |
| Insufficient payload (model declined to judge) | 0.128 | 0.043 |
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".