Anti-Myeloperoxidase Antineutrophil Cytoplasmic Antibody-Associated Vasculitis Results in Aortic Valvulitis and Severe Aortic Regurgitation
Bibliographic record
Abstract
Background Anti-Myeloperoxidase (MPO) Antineutrophil Cytoplasmic Antibody (ANCA) Associated Vasculitis (AAV) is 1 of the 2 major forms of the ANCA-associated vasculidities. It results in necrotizing systemic inflammation of small blood vessels, most commonly affecting the lungs and kidneys.[1] Cardiac involvement in this disorder is known to occur, however aortic valvular disease is an uncommon manifestation.[2,3] Case We report the case of a 65-year-old female with a history of Anti-MPO AAV who was initially diagnosed with manifestations of sensorineural hearing loss and scleritis, and who was treated with methotrexate. Transthoracic echocardiogram at diagnosis demonstrated mild-moderate aortic regurgitation and normal biventricular function. Six months later, she presented with worsening dyspnea and was found to have significant hypotension and elevated serum lactate. Transesophageal echocardiography was performed and revealed severe aortic regurgitation with a central coaptation defect, severe left ventricular dysfunction, and no vegetations consistent with infective endocarditis. She underwent urgent surgical aortic valve replacement and stabilized with this intervention. Peripheral blood cultures were negative, and aortic valve pathology demonstrated active necrotizing valvulitis with negative microbiological stains. A diagnosis of Anti-MPO AAV valvulitis was made, and treatment with glucocorticoids and rituximab was initiated. Conclusion Though rare, aortic valvulitis and resultant aortic regurgitation is a possible manifestation of Anti-MPO AAV and should be considered as a possible etiology of new heart failure or shock in these patients. [1.] Arnold S. Lancet Rheumatol 2024;6(5):e300-13. [2.] Lacoste C. BMC Musculoskelet Disord 2011;12:50. [3.] Jeantin L. J Rheumatol 2022;49(12):1349-55.
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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) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| 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".