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. 2023 Jun 15;330(1):78–80. doi: 10.1001/jama.2023.8288

Table. Representative Examples of AI-Generated Differential Diagnoses Compared With the Final Complex Diagnostic Challenge Diagnosis, Along With Subsequent Differential Quality Score.

Final diagnosis Final GPT-4 diagnosis List of diagnoses Differential quality score
Encephalitis due to Behçet disease Neuro-Behçet disease

  • Neuro-Behçet disease

  • Viral meningitis (eg, due to human rhinovirus or enterovirus)

  • Bacterial meningitis

  • Tuberculous meningitis

  • Fungal meningitis (eg, cryptococcal meningitis)

  • Primary central nervous system vasculitis

  • Central nervous system lymphoma

  • Neurosarcoidosis

  • Central nervous system lupus

  • Multiple sclerosis

 5 (the actual diagnosis was suggested in the differential)
Regional myocarditis due to infection with Listeria monocytogenes Lyme carditis

  • Lyme carditis

  • Giant cell myocarditis

  • Viral myocarditis (eg, Coxsackievirus, adenovirus)

  • Bacterial endocarditis

  • Sarcoidosis

  • Chagas disease (Trypanosoma cruzi infection)

  • Autoimmune myocarditis (eg, systemic lupus erythematosus)

  • Drug-induced myocarditis

  • Parvovirus B19 myocarditis

  • Toxoplasmosis myocarditis

 4 (the suggestions included something very close, but not exact)
Erysipelothrix rhusiopathiae infection Streptococcus pyogenes cellulitis with possible necrotizing fasciitis

  • S pyogenes cellulitis with possible necrotizing fasciitis

  • Staphylococcus aureus cellulitis with possible necrotizing fasciitis

  • Pasteurella multocida cellulitis from animal exposure

  • Capnocytophaga canimorsus cellulitis from animal exposure

  • Clostridium perfringens gas gangrene or myonecrosis

  • Vibrio vulnificus cellulitis (but less likely due to lack of water exposure)

  • Compartment syndrome secondary to inflammation and swelling

  • Erysipelas caused by group A streptococcus

  • Lyme disease–associated cellulitis (unlikely due to rapid onset and severity)

 3 (the suggestions included something closely related that might have been helpful)
Cerebral amyloid angiopathy–related inflammation Autoimmune encephalitis (possibly anti-NMDA receptor encephalitis)

  • Autoimmune encephalitis (eg, anti-NMDA receptor encephalitis, anti-LGI1 encephalitis, anti-CASPR2 encephalitis)

  • CNS vasculitis (eg, primary CNS vasculitis, secondary vasculitis due to systemic autoimmune disease)

  • CNS lymphoma

  • Paraneoplastic limbic encephalitis (eg, associated with small cell lung cancer, breast cancer, or ovarian cancer)

  • Infectious encephalitis (eg, herpes simplex virus encephalitis, West Nile virus encephalitis)

  • Creutzfeldt-Jakob disease

  • Sarcoidosis with CNS involvement

  • Progressive multifocal leukoencephalopathy

  • Metabolic or toxic encephalopathy (eg, hepatic or uremic encephalopathy, Wernicke encephalopathy)

 2 (the suggestions included something related, but unlikely to be helpful)
Anti–melanoma differentiation–associated protein 5 dermatomyositis Coccidioidomycosis (Valley fever)

  • Coccidioidomycosis (Valley fever)

  • Systemic lupus erythematosus

  • Disseminated histoplasmosis

  • Behçet disease

  • Mixed connective tissue disease

  • Paraneoplastic syndrome

  • Reactive arthritis

  • Sarcoidosis

  • Vasculitis (eg, granulomatosis with polyangiitis)

  • Parvovirus B19 infection

 0 (no suggestions were close to the target diagnosis)

Abbreviations: AI, artificial intelligence; CASPR2, contactin-associated protein-like 2; CNS, central nervous system; GPT-4; Generative Pre-trained Transformer 4; LGI1, leucine-rich glioma-inactivated protein 1; NMDA, N-methyl-d-aspartate.