A 67-year-Old Immunocompromised Male Presenting With Right Upper-Quadrant Abdominal Pain and Hepatic Lesions
Bibliographic record
Abstract
A 67-year-old male presented to a tertiary care hospital in Winnipeg (Manitoba, Canada) with a 4-month history of right upper-quadrant abdominal pain, worsening over 2 weeks. He reported night sweats and 15 pounds of weight loss over the past year. Six months prior, he underwent allogeneic stem cell transplant for acute myeloid leukemia. Subsequently, he received tacrolimus for 7 months and required rituximab for Epstein–Barr virus (EBV) reactivation. His past medical history included Crohn's disease (no active treatment), hypertension, left below-knee amputation, benign prostatic hyperplasia, and heart failure. He lives in Winnipeg and has a dog that spends significant time outdoors hunting rodents, particularly squirrels. There was no relevant travel history. On physical examination, he was afebrile and hemodynamically stable, with right upper abdomen tenderness. White blood cell count, electrolytes, serum creatinine, aspartate aminotransferase, and alanine aminotransferase were normal. Alkaline phosphatase (214U/L) and C-reactive protein (107 mg/L) were elevated. Magnetic resonance imaging (MRI) demonstrated a multicystic infiltrating lesion in the right hepatic lobe (Figure 1). Blood cultures, serum galactomannan, serology for Entamoeba histolytica and Echinococcus spp. and peripheral blood EBV polymerase chain reaction (PCR) were negative. Liver biopsy was performed, with specimens sent for microbiology and pathology. Cultures of the biopsy sample for bacteria, mycobacteria, and fungi were negative. Hematoxylin and Eosin (H&E) sections of the liver biopsy demonstrated extensive necrosis and foci of granulomatous inflammation. Gomori Methenamine Silver (GMS) and Periodic Acid-Schiff (PAS) stains highlighted numerous, irregular variably sized structures (Figure 2).
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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 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
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".