Unexplained Fever in a Hemodialysis Patient Possibly due to Cat Scratch Disease Opportunistic Infection
Bibliographic record
Abstract
INTRODUCTION: Cat Scratch Disease, caused by the bacterium Bartonella henselae, typically manifests with fever, headache, anorexia, weight loss, tender lymphadenopathy, and other systemic symptoms. Transmission commonly occurs through a cat scratch or bite. The clinical course varies depending on the patient's immune status, notably in individuals with conditions such as renal failure. While generally localized, Cat Scratch Disease can occasionally present as a systemic illness with diverse manifestations. This report aims to elucidate the etiology of fever of unknown origin in hemodialysis patients, focusing on the case of a 30-year-old female. METHODS: A 30-year-old female patient, who routinely undergoes hemodialysis (HD) three times a week for four hours at the hemodialysis unit, was admitted to our service for further evaluation and treatment due to an infectious disease clinic presentation. She is now under close observation and management in our inpatient department. FINDINGS: The patient's presenting symptoms included fever, arthralgia, night sweats, and weight loss, refractory to empirical antibiotic and broad-spectrum antimicrobial therapy. Physical examination revealed lymphadenopathy and splenomegaly. Laboratory investigations demonstrated elevated C-reactive protein and procalcitonin levels. Ultrasound imaging revealed reactive lymphadenopathy in multiple regions. Following the exclusion of bacterial, viral, and mycobacterial infections, including tuberculosis, a diagnosis of lymphoma was considered. However, a subsequent lymph node biopsy revealed non-caseating granulomatous lymphadenitis, a histopathological finding consistent with Cat Scratch Disease. DISCUSSION: Although rare, Cat Scratch Disease should be considered in the differential diagnosis of fever of unknown origin in patients with chronic kidney disease undergoing hemodialysis.
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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 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 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 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".