Une échinococcose alvéolaire atypique d’évolution systémique chez une patiente traitée par dupilumab
Bibliographic record
Abstract
L’échinococcose alvéolaire est une parasitose endémique sévissant dans certaines zones froides de l’hémisphère Nord incluant notamment l’Est de la France, la Suisse, l’Allemagne, le Canada ou les États-Unis. Largement sous-diagnostiquée, elle est liée à l’infection par Echinococcus multilocularis, un petit taenia appartenant à la classe des cestodes, pouvant entraîner une atteinte multisystémique notamment chez le patient âgé ou immunodéprimé. Nous rapportons le cas d’une patiente de 82 ans, immunodéprimée par une corticothérapie prolongée et un traitement par dupilumab. Elle était adressée dans notre service pour bilan diagnostique de lésions hépatiques et pulmonaires atypiques, initialement suspectes de tuberculose ou de maladie associée aux IgG4. L’hypothèse d’une échinococcose alvéolaire à E. multilocularis a pu être évoquée sur un faisceau d’arguments, puis confirmée par diagnostic moléculaire. Nous évoquons et discutons le rôle du dupilumab dans l’évolution systémique et la présentation atypique de la maladie, par l’induction d’une immunodépression spécifique. L’échinococcose alvéolaire devrait être systématiquement recherchée en cas de maladie systémique comprenant une atteinte hépatique et pulmonaire au premier plan, surtout chez le sujet immunodéprimé. Alveolar echinococcosis is an endemic parasitic disease prevalent in certain cold regions of the Northern Hemisphere, including Eastern France, Switzerland, Germany, Canada, and the United States. Widely underdiagnosed, it is associated with infection by Echinococcus multilocularis, a small tapeworm belonging to the cestode class, capable of causing multi-systemic involvement, particularly in elderly or immunocompromised patients. We present the case of an 82-year-old patient, immunocompromised due to prolonged corticosteroid therapy and treatment with dupilumab. She was referred to our department for a diagnostic assessment of atypical hepatic and pulmonary lesions, initially suspected of tuberculosis or an IgG4-related disease. The hypothesis of alveolar echinococcosis caused by E. multilocularis was eventually considered based on a set of arguments, further confirmed by molecular diagnosis. We discuss the role of dupilumab in the systemic evolution and atypical presentation of the disease, through the induction of a specific immunosuppression. Alveolar echinococcosis should be systematically considered in case of systemic disease with prominent hepatic and pulmonary involvement, especially in immunocompromised patients.
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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 | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.001 | 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; both teacher heads agree on what is shown here.
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".