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 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) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 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".