Disseminated Cutaneous Blastomycosis
Bibliographic record
Abstract
A 66-year-old woman with a history of metastatic colon adenocarcinoma and sarcoidosis presented with a 4-month history of widespread ulcerated, hyperkeratotic, verrucous plaques with violaceous borders on the face, trunk and limbs, measuring up to 5 cm (Figure 1a). She had recently undergone home renovations due to water damage. She reported no systemic symptoms. Skin biopsy and culture revealed broad-based budding yeast forms consistent with Blastomyces dermatitidis (Figure 1b), confirming disseminated cutaneous blastomycosis. Chest X-ray showed no pulmonary involvement. Oral itraconazole was initiated, leading to significant clinical improvement. Blastomycosis is a systemic fungal infection endemic to parts of North America. This case highlights the importance of including blastomycosis in the differential diagnosis of verrucous nodules or ulcers, particularly in patients with relevant travel or environmental exposure in endemic regions such as Southern Quebec, where incidence has been rising. Lorena Alexandra Mija: writing – original draft preparation. Elio Kechichian and Carolina Lucena Fernandes: conceptualisation, methodology, supervision. All patients in this manuscript have given written informed consent for participation in the study and the use of their deidentified, anonymized, aggregated data and their case details (including photographs) for publication. Ethical Approval: Not applicable. The authors declare no conflicts of interest. Data sharing is not applicable to this article as no new data were created or analyzed in this study.
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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 | 0.001 | 0.024 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| 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".