Delayed-onset drug-induced liver injury in a cystic fibrosis patient on long-term elexacaftor/ivacaftor/tezacaftor therapy: A case report and literature review
Why this work is in the frame
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Bibliographic record
Abstract
Background: Elexacaftor/tezacaftor/ivacaftor (ETI) is a cystic fibrosis transmembrane conductance regulator (CFTR) modulator widely used in patients with cystic fibrosis (CF), typically associated with mild, early onset liver enzyme elevations. Methods: We report a case of a 35-year-old man with CF who developed a marked hepatic transaminitis, with an alanine aminotransferase peaking at >1,000 IU/L after 30 months of stable ETI therapy. The patient was asymptomatic, and an extensive workup excluded viral, autoimmune, and metabolic liver disease. Various imaging modalities excluded other secondary causes, such as portal venous or arterial thromboses. Results: Using the Roussel Uclaf Causality Assessment Method (RUCAM), a score of 8 indicated a probable link to drug-induced liver injury (DILI), which was further supported by World Health Organization-Uppsala Monitoring Centre (WHO-UMC) causality assessment. Conclusions: This case highlights the potential for delayed-onset hepatotoxicity with ETI and emphasizes the need for continued liver monitoring during long-term therapy.
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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 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| 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 it