Progressive Fibrosis in Hydroxychloroquine Cardiomyopathy Mimicking Hypertrophic Cardiomyopathy and Cardiac Amyloidosis
Bibliographic record
Abstract
BACKGROUND: Early recognition of hydroxychloroquine cardiotoxicity is crucial given its potential reversibility; however, the diagnosis can be complicated by imaging findings that overlap with other infiltrative cardiomyopathies, including cardiac amyloidosis. CASE SUMMARY: A 62-year-old woman with systemic lupus erythematosus on hydroxychloroquine therapy (>15 years, cumulative dose: >2000 g) presented with progressive heart failure. Serial cardiac magnetic resonance imaging performed over 5 years showed evolution from extensive myocardial fibrosis (37%) to infiltrative cardiomyopathy. Technetium-99m-pyrophosphate scintigraphy demonstrated diffuse myocardial uptake. Endomyocardial biopsy confirmed hydroxychloroquine cardiotoxicity and the absence of amyloid involvement by Congo red staining. DISCUSSION: This case documents the 5-year imaging evolution of hydroxychloroquine cardiotoxicity, representing a rare cause of false-positive pyrophosphate scintigraphy. TAKE-HOME MESSAGES: Hydroxychloroquine cardiotoxicity should be considered when pyrophosphate scintigraphy is positive in patients with long-term exposure. Early recognition (before extensive fibrosis develops) is critical, as the likelihood of recovery diminishes with advanced disease.
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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 | 0.001 |
| 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 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".