Acute respiratory distress syndrome (ARDS) secondary to <i>Blastomyces dermatitidis</i> masquerading as a malignancy: A case report and clinical pearls
Bibliographic record
Abstract
A 73-year-old woman with type 2 diabetes presented with progressive hypoxemia requiring intubation. Her diagnosis was thought to be secondary to metastatic malignancy based on imaging. A high-risk biopsy was obtained using endobronchial ultrasound (EBUS), while intubated and requiring 100% oxygen. Pathological samples were negative for malignancy but demonstrated broad-based budding yeast, consistent with Blastomyces dermatitidis. Blastomyces is endemic in North America around river valleys with recent increasing incidence. Respiratory illness akin to pneumonia is typical, severe disease usually occurs in immunocompromised hosts. Our case is unique in its fulminant respiratory failure in a mildly immunocompromised individual with well-controlled diabetes. We also describe challenges associated with acquiring tissue samples, and the importance of pathological sampling for diagnosis and avoiding premature closure bias. Although rare, as both blastomycosis and immunocompromising therapies become more common, risk of severe blastomycosis is increased; it must therefore be on the differential of nonresolving pneumonia or acute respiratory distress syndrome (ARDS).
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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 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.005 | 0.003 |
| Insufficient payload (model declined to judge) | 0.002 | 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".