BI21 Intermittent and progressive pustular psoriasis during chemotherapy cycles in a toddler
Bibliographic record
Abstract
Abstract An 18-month-old with high-risk stage IV neuroblastoma was referred for the difficult evaluation of an intermittent and evolving rash. He presented with erythematous, pruritic papules on his chest, under his portal catheter dressing. After a change of dressing type, this progressed, with a pustular, pruritic eruption across his scalp. Differential diagnoses included eosinophilic folliculitis, contact dermatitis and transfusion reaction. Viral and bacterial swabs and an open application test to chlorhexidine were negative. Topical betamethasone valerate 0.1% gave improvement. Just before his next chemotherapy cycle (cisplatin and etoposide), the rash recurred as a pruritic pustular eruption across the frontal and retroauricular scalp; skin biopsy suggested nonspecific subacute eczematous dermatitis. A lack of eosinophils was suspicious, but blood counts showed absent circulating eosinophils. From December to April, the rash regularly improved after chemotherapy but then recurred and progressed as counts recovered prior to his next cycle. Differentials including Demodex, Pityrosporum, dermatitis with koebnerization and chemotherapy reactions such as neutrophilic eccrine hidradenitis were considered. Topical ivermectin and ketoconazole did not help. He had partial response to topical corticosteroids including clobetasol propionate 0.05%. A second biopsy was taken due to clinical suspicion of psoriasis, and 10 days of oral prednisolone was given to try to clear his skin for autologous stem cell transplantation (HSCT). Biopsy described acanthosis and elongated rete ridges, parakeratosis with neutrophils, and blood vessels extending into dermal papillae in keeping with psoriasis. Fortunately the condition improved substantially and he successfully underwent HSCT with granulocyte colony-stimulating factor (GCSF). For the following 2 months’ cycles, the rash did not recur, but after his second HSCT with GCSF it recurred and continued to spread as cell counts normalized. A few isolated face and scalp lesions quickly spread with pruritic erythematous papules. Many had scale, some had a collarette of scale, and some were pustular and some hyperpigmented. They were extensive over the back with less abdominal involvement. Herpes simplex virus and varicella zoster virus swabs, KOH scrapes and human herpesvirus-6 were negative. He was treated with topical calcipotriol and mometasone 0.1%, with consideration of acitretin should he not improve. Fortunately, the rash settled with topical therapy and time. After completing proton radiotherapy prior to tumour resection, he had six cycles of maintenance immunotherapy (dinutuximab) with no recurrence of the rash, despite monthly GCSF, and good cell counts, and has now completed his oncological therapy.
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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 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 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".