P0648 CHRONIC T‐CELL ASSOCIATED EPSTEIN‐BARR VIRUS (EBV) INFECTION MIMICKING PEDIATRIC INFLAMMATORY BOWEL DISEASE (IBD)
Bibliographic record
Abstract
Introduction: Chronic active EBV infection in which the infection is T cell, rather than B-cell driven, is increasingly being recognized as a cause of lymphoproliferative disorders in non-transplant patients. We present the case of a child with this disease who was initially diagnosed with IBD. Methods: A 9 yr old boy presented with a four year history of a debilitating chronic illness characterized by abdominal pain, diarrhea and vomiting, weight loss, anorexia, fatigue and intermittent fever. Initially, a diagnosis of colonic Crohn’s disease was entertained on the basis of patchy chronic inflammation but without granulomata. He was treated with steroids with almost complete symptom resolution but weaning proved difficult to achieve. Immunosuppressant therapy with azathioprine and methotrexate was unhelpful. He had been on almost continual therapy with prednisone in varying dosage throughout the four years preceding admission, with concomitant growth failure and poor nutrition. He developed significant hepatosplenomegaly and intra-abdominal lymphadenopathy with multiple hypodense splenic lesions, intermittent oral and skin ulceration, and high swinging fever whenever steroids were reduced. Results: Investigation was negative for angioimmunoblastic lymphadenopathy, chronic granulomatous disease, Job’s and Castleman’s syndromes, systemic mastocytosis, and metabolic storage diseases. Liver biopsy in early 2003 showed a mild portal and lobular infiltrate and EBER positivity. Laparotomy for splenic, liver and lymph node examination showed marked EBV positivity in monoclonal T cells. Gut mucosal biopsies were also EBV-positive. EBV viral loads were markedly elevated with positive EBV-VCA and EBNA. His symptoms have once again remitted on steroids and he is being considered for allogeneic bone marrow (BM) stem cell transplantation. His prognosis remains guarded. Conclusion: There are few reports of gut involvement with chronic EBV infection. Though this may initially mimic IBD, the development of a lymphoproliferative syndrome eventually enabled the diagnosis to be made. Examples of T-cell driven chronic EBV-related disorders also include hemophagocytic syndromes and T-cell/NK-cell driven lymphomas. In this context, BM stem cell transplantation may be helpful but the condition is still associated with significant morbidity and mortality.
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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 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 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".