feat: add 8 multi-specialty evaluation scenarios with 4 new patient profiles

Expand evaluation suite from 10 to 18 cases covering cardiology,
neurology, psychiatry, pediatrics, nephrology, endocrinology,
pulmonology, and general practice. Add 4 new patient profiles
(epilepsy/HLA-A*31:01, pediatric ALL/TPMT, CKD/diabetes, elderly
polypharmacy/CYP2D6 PM). All 18/18 cases pass mock evaluation with
94.4% KG grounding, 100% safety, 88.9% hygiene.

Co-Authored-By: Claude Opus 4.6 <noreply@anthropic.com>

Author: AlexMikhalev

crates/terraphim-demo/src/patients.rs

@@ -173,6 +173,267 @@ pub fn get_afib_patient() -> PatientProfile {
     }
 }
 
+/// Epilepsy patient with HLA-A*31:01 -- carbamazepine SJS risk
+pub fn get_epilepsy_patient() -> PatientProfile {
+    PatientProfile {
+        id: "DEMO-EPILEPSY-001".to_string(),
+        age: 34,
+        sex: "Female".to_string(),
+        weight_kg: 62.0,
+        height_cm: 165,
+        medical_history: vec![
+            "Focal epilepsy (diagnosed age 22)".to_string(),
+            "Migraine with aura".to_string(),
+        ],
+        diagnoses: vec![
+            "Drug-resistant focal epilepsy".to_string(),
+            "HLA-A*31:01 positive".to_string(),
+        ],
+        genomic_variants: vec![GenomicVariant {
+            gene: "HLA-A".to_string(),
+            variant: "*31:01".to_string(),
+            significance: "Increased risk of carbamazepine-induced SJS/TEN and DRESS".to_string(),
+            allele_frequency: None,
+        }],
+        pgx_profile: PGxProfile {
+            cyp2d6: Some("*1/*1".to_string()),
+            cyp2c19: Some("*1/*1".to_string()),
+            cyp2c9: Some("*1/*1".to_string()),
+            cyp3a4: Some("*1/*1".to_string()),
+            cyp3a5: None,
+            dpyvd: None,
+            tpmt: None,
+        },
+        current_medications: vec![Medication {
+            name: "Carbamazepine".to_string(),
+            dose: "400mg".to_string(),
+            frequency: "Twice daily".to_string(),
+            start_date: Some("2024-06-01".to_string()),
+        }],
+        allergies: vec!["Penicillin (hives)".to_string()],
+        ecog_performance_status: 0,
+        prior_treatments: vec![PriorTreatment {
+            treatment: "Levetiracetam 1500mg BID".to_string(),
+            indication: "Focal epilepsy".to_string(),
+            response: TreatmentResponse::PartialResponse,
+            start_date: Some("2022-01-15".to_string()),
+            end_date: Some("2024-05-01".to_string()),
+            reason_for_stop: Some(
+                "Inadequate seizure control, behavioral side effects".to_string(),
+            ),
+        }],
+        clinical_note: "34-year-old female with drug-resistant focal epilepsy, recently started \
+            on carbamazepine 400mg BID. HLA-A*31:01 genotyping returned positive. \
+            Assess risk of Stevens-Johnson syndrome and recommend alternative anticonvulsant."
+            .to_string(),
+    }
+}
+
+/// Pediatric ALL patient with TPMT *1/*3A -- mercaptopurine dose adjustment
+pub fn get_pediatric_all_patient() -> PatientProfile {
+    PatientProfile {
+        id: "DEMO-PEDS-ALL-001".to_string(),
+        age: 7,
+        sex: "Male".to_string(),
+        weight_kg: 23.0,
+        height_cm: 122,
+        medical_history: vec![
+            "Acute lymphoblastic leukemia (B-cell precursor, standard risk)".to_string(),
+        ],
+        diagnoses: vec![
+            "B-cell precursor ALL, standard risk".to_string(),
+            "TPMT *1/*3A (intermediate metabolizer)".to_string(),
+        ],
+        genomic_variants: vec![GenomicVariant {
+            gene: "TPMT".to_string(),
+            variant: "*1/*3A".to_string(),
+            significance: "Intermediate metabolizer -- reduced thiopurine metabolism".to_string(),
+            allele_frequency: None,
+        }],
+        pgx_profile: PGxProfile {
+            cyp2d6: None,
+            cyp2c19: None,
+            cyp2c9: None,
+            cyp3a4: None,
+            cyp3a5: None,
+            dpyvd: None,
+            tpmt: Some("*1/*3A".to_string()),
+        },
+        current_medications: vec![
+            Medication {
+                name: "Mercaptopurine".to_string(),
+                dose: "50mg/m2".to_string(),
+                frequency: "Once daily (maintenance phase)".to_string(),
+                start_date: Some("2025-09-01".to_string()),
+            },
+            Medication {
+                name: "Methotrexate".to_string(),
+                dose: "20mg/m2".to_string(),
+                frequency: "Weekly (maintenance phase)".to_string(),
+                start_date: Some("2025-09-01".to_string()),
+            },
+        ],
+        allergies: vec![],
+        ecog_performance_status: 0,
+        prior_treatments: vec![PriorTreatment {
+            treatment: "Induction chemotherapy (COG AALL0434)".to_string(),
+            indication: "B-cell precursor ALL".to_string(),
+            response: TreatmentResponse::CompleteResponse,
+            start_date: Some("2025-03-01".to_string()),
+            end_date: Some("2025-08-31".to_string()),
+            reason_for_stop: Some("Completed induction, moved to maintenance".to_string()),
+        }],
+        clinical_note: "7-year-old male with standard-risk B-cell precursor ALL in maintenance \
+            phase. TPMT genotyping shows *1/*3A (intermediate metabolizer). Currently on \
+            standard-dose mercaptopurine 50mg/m2 daily. Assess need for dose reduction \
+            to prevent myelosuppression."
+            .to_string(),
+    }
+}
+
+/// CKD patient with diabetes -- renal dosing considerations
+pub fn get_ckd_patient() -> PatientProfile {
+    PatientProfile {
+        id: "DEMO-CKD-001".to_string(),
+        age: 68,
+        sex: "Male".to_string(),
+        weight_kg: 88.0,
+        height_cm: 178,
+        medical_history: vec![
+            "Type 2 diabetes mellitus (15 years)".to_string(),
+            "Hypertension (20 years)".to_string(),
+            "Chronic kidney disease stage 3b".to_string(),
+            "Gout".to_string(),
+        ],
+        diagnoses: vec![
+            "CKD stage 3b (eGFR 38 mL/min/1.73m2)".to_string(),
+            "Type 2 diabetes mellitus".to_string(),
+            "Essential hypertension".to_string(),
+        ],
+        genomic_variants: vec![GenomicVariant {
+            gene: "CYP2C9".to_string(),
+            variant: "*1/*3".to_string(),
+            significance: "Reduced CYP2C9 function -- affects NSAID and sulfonylurea metabolism"
+                .to_string(),
+            allele_frequency: None,
+        }],
+        pgx_profile: PGxProfile {
+            cyp2d6: Some("*1/*1".to_string()),
+            cyp2c19: Some("*1/*1".to_string()),
+            cyp2c9: Some("*1/*3".to_string()),
+            cyp3a4: Some("*1/*1".to_string()),
+            cyp3a5: None,
+            dpyvd: None,
+            tpmt: None,
+        },
+        current_medications: vec![
+            Medication {
+                name: "Metformin".to_string(),
+                dose: "1000mg".to_string(),
+                frequency: "Twice daily".to_string(),
+                start_date: Some("2018-03-01".to_string()),
+            },
+            Medication {
+                name: "Lisinopril".to_string(),
+                dose: "20mg".to_string(),
+                frequency: "Once daily".to_string(),
+                start_date: Some("2015-01-10".to_string()),
+            },
+            Medication {
+                name: "Glipizide".to_string(),
+                dose: "10mg".to_string(),
+                frequency: "Twice daily".to_string(),
+                start_date: Some("2021-06-01".to_string()),
+            },
+        ],
+        allergies: vec!["Iodine contrast (anaphylaxis)".to_string()],
+        ecog_performance_status: 1,
+        prior_treatments: vec![],
+        clinical_note: "68-year-old male with CKD stage 3b (eGFR 38), long-standing type 2 \
+            diabetes and hypertension. Currently on metformin 1000mg BID, glipizide 10mg BID, \
+            lisinopril 20mg daily. CYP2C9 *1/*3 genotype. Review medication safety given \
+            declining renal function, assess need for NSAID avoidance and metformin adjustment."
+            .to_string(),
+    }
+}
+
+/// Elderly polypharmacy patient -- CYP2D6 PM, depression + COPD + osteoporosis
+pub fn get_elderly_polypharmacy_patient() -> PatientProfile {
+    PatientProfile {
+        id: "DEMO-POLYPHARM-001".to_string(),
+        age: 78,
+        sex: "Female".to_string(),
+        weight_kg: 55.0,
+        height_cm: 158,
+        medical_history: vec![
+            "Major depressive disorder (recurrent)".to_string(),
+            "COPD (GOLD stage II)".to_string(),
+            "Osteoporosis (vertebral fracture 2024)".to_string(),
+            "Hypertension".to_string(),
+            "Fall with hip contusion (2025)".to_string(),
+        ],
+        diagnoses: vec![
+            "Major depressive disorder, recurrent".to_string(),
+            "COPD GOLD stage II".to_string(),
+            "Osteoporosis with pathological fracture".to_string(),
+            "CYP2D6 poor metabolizer (*4/*4)".to_string(),
+        ],
+        genomic_variants: vec![GenomicVariant {
+            gene: "CYP2D6".to_string(),
+            variant: "*4/*4".to_string(),
+            significance: "Poor metabolizer -- reduced metabolism of many psychotropics"
+                .to_string(),
+            allele_frequency: None,
+        }],
+        pgx_profile: PGxProfile {
+            cyp2d6: Some("*4/*4".to_string()),
+            cyp2c19: Some("*1/*1".to_string()),
+            cyp2c9: Some("*1/*1".to_string()),
+            cyp3a4: Some("*1/*1".to_string()),
+            cyp3a5: None,
+            dpyvd: None,
+            tpmt: None,
+        },
+        current_medications: vec![
+            Medication {
+                name: "Amlodipine".to_string(),
+                dose: "5mg".to_string(),
+                frequency: "Once daily".to_string(),
+                start_date: Some("2020-01-15".to_string()),
+            },
+            Medication {
+                name: "Alendronate".to_string(),
+                dose: "70mg".to_string(),
+                frequency: "Once weekly".to_string(),
+                start_date: Some("2024-08-01".to_string()),
+            },
+            Medication {
+                name: "Tiotropium".to_string(),
+                dose: "18mcg".to_string(),
+                frequency: "Once daily (inhaler)".to_string(),
+                start_date: Some("2023-04-01".to_string()),
+            },
+        ],
+        allergies: vec!["Codeine (nausea/vomiting)".to_string()],
+        ecog_performance_status: 2,
+        prior_treatments: vec![PriorTreatment {
+            treatment: "Paroxetine 20mg daily".to_string(),
+            indication: "Major depressive disorder".to_string(),
+            response: TreatmentResponse::PartialResponse,
+            start_date: Some("2023-01-01".to_string()),
+            end_date: Some("2025-06-01".to_string()),
+            reason_for_stop: Some(
+                "Excessive sedation, falls, anticholinergic side effects".to_string(),
+            ),
+        }],
+        clinical_note: "78-year-old female with recurrent MDD, COPD, osteoporosis. CYP2D6 *4/*4 \
+            poor metabolizer. Prior paroxetine discontinued due to falls and anticholinergic \
+            burden. Needs antidepressant selection considering CYP2D6 PM status, fall risk, \
+            COPD, and polypharmacy. Apply Beers criteria and deprescribing principles."
+            .to_string(),
+    }
+}
+
 #[cfg(test)]
 mod tests {
     use super::*;
@@ -194,4 +455,40 @@ mod tests {
         assert_eq!(patient.age, 72);
         assert!(patient.pgx_profile.cyp2c9.is_some());
     }
+
+    #[test]
+    fn test_epilepsy_patient_creation() {
+        let patient = get_epilepsy_patient();
+        assert_eq!(patient.id, "DEMO-EPILEPSY-001");
+        assert_eq!(patient.age, 34);
+        assert_eq!(patient.sex, "Female");
+        assert!(patient
+            .genomic_variants
+            .iter()
+            .any(|v| v.gene == "HLA-A" && v.variant == "*31:01"));
+    }
+
+    #[test]
+    fn test_pediatric_all_patient_creation() {
+        let patient = get_pediatric_all_patient();
+        assert_eq!(patient.id, "DEMO-PEDS-ALL-001");
+        assert_eq!(patient.age, 7);
+        assert!(patient.pgx_profile.tpmt.is_some());
+    }
+
+    #[test]
+    fn test_ckd_patient_creation() {
+        let patient = get_ckd_patient();
+        assert_eq!(patient.id, "DEMO-CKD-001");
+        assert_eq!(patient.age, 68);
+        assert_eq!(patient.pgx_profile.cyp2c9.as_deref(), Some("*1/*3"));
+    }
+
+    #[test]
+    fn test_elderly_polypharmacy_patient_creation() {
+        let patient = get_elderly_polypharmacy_patient();
+        assert_eq!(patient.id, "DEMO-POLYPHARM-001");
+        assert_eq!(patient.age, 78);
+        assert_eq!(patient.pgx_profile.cyp2d6.as_deref(), Some("*4/*4"));
+    }
 }