Bibliographic record
Abstract
Abstract INTRODUCTION Our case illustrates the challenges of diagnosing and treating lung disease in the setting of RA and immunosuppression. CASEA 65 yo female with RA, (treated with rituximab 10 months prior), Myelodysplastic syndrome, remote Aplastic anemia without prior lung disease presented with back pain, cough and lower lobe pulmonary opacities consistent with pneumonia. Her medications included tylenol and naproxen-esomeprazole. She had never smoked, vaped, or used recreational drugs. There were no environmental exposures. She received 10 days of clavulin. Symptoms and labs normalized, however there was incomplete radiographic resolution one month later. Spirometry was normal but there was reduction in diffusing capacity. Three months later, similar symptoms occurred. A CT showed new upper lobe peripheral opacities. White blood cell count and differential was normal. C-reactive protein was 78 m/ mL. On bronchoscopy, all bacterial, fungal, mycobacterial and viral studies were normal. Transbronchial biopsies demonstrated patchy chronic interstitial pneumonitis without granuloma, vasculitis, infection, or malignancy. A working diagnosis of organizing pneumonia was made. She was initiated on prednisone 50 mg OD and PJP prophylaxis in December with a planned 6 month taper. While her respiratory symptoms and pulmonary opacities improved, in March she received rituximab for RA flare. By April, her exertional dyspnea and dry cough reached a plateau. By May, on 15 mg of prednisone, symptoms gradually worsened and forced vital capacity declined by 10%. She denied sputum, fevers, chills, or viral symptoms. Her exam was unremarkable. A CT chest showed bilateral lower lobe opacities, patchy ground glass, minor reticulation, and traction bronchiectasis. Consensus from ILD Multidisciplinary Rounds was that this was connective tissue disease-related ILD and mycophenolate should be initiated. Although no infectious symptoms, out of caution a bronchoscopy was performed. Unexpectedly, the lavage demonstrated Covid and all other investigations were negative. She received 10 days of remdesivir, a dose of intravenous immunoglobulin G, and continued on prednisone 10 mg with rapid resolution of symptoms and improvement of radiographic findings. Ten days of nirmatrelvir with ritonavir were given to facilitate complete Covid clearance. A CT chest 3 months after the admission demonstrated resolution of the majority of abnormalities. DISCUSSION Pulmonary manifestations of RA can include organizing pneumonia, interstitial lung disease, bronchiectasis, pulmonary arterial hypertension, pleural effusion, and increased risk of infection due to immunosuppression. While Covid can also cause organizing pneumonia and pulmonary fibrosis, our case highlights how prolonged Covid infection without classic symptoms or hypoxia can mimic ILD.
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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 | 0.000 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.002 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 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 teacher head, 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".