Reviewer ’s report  
 
Title: Invasive intestinal Mucormycosis in a 40 -year old immunocompetent patient ⸻ a rarely 
reported clinical phenomenon: A case report  
 
Version: 0 Date: 18 Oct 2019  
 
Reviewer: Philipp Emanuel Kaiser  
 
Reviewer's report:  
 
Abdi et al present a case of invasive mucormycosis in patient lacking classical risk factors f or 
invasive fungal disease but alcoholism and most probably alcoholic liver cirrhosis. Similar cases 
have been published before, nonetheless the existance of such cases appears noteworthy.  
 
However, the report in its current form is not suitable for publica tion. Obviously language -
related issues need to be addressed (grammatical, orthographical as well as idiomatical). 
Furthermore several content -related points have to be clarified:  
 
 
Case presentation:  
 
- was the patient in septic shock at presentation?  
 
- was he manourished?  
 
- the authors mention icterus and hyperbilirubinemia. Is there overt liver disease? (CT and 
sonography suggest cirrhosis)  
 
- pathognomonic of zygomycete fungal infection are broad thin -walled nonseptate hyphae that 
branch at right angels (wording!), which can be discerned on the histological photographs. If 
available a picture showing angioinvasion should be included.  
 
- the patient underwent laparatomy for cholecystectomy: Was the diagnosis "cholecystitis" 
proven? Were histologic studies done on the gall bladder? Intraoperative findings: colonic 
adhesions?  
 
- Most striking in this case is its benign course and good outcome: As stated in the manuscript 
intestinal has a high mortality and is often only diagnosed histologically after resectio n of 
necrotic parts of the intestine. Although the patient had systemical signs of infection, the alleged 
angioinvasive infection healed without surgery and after a extremely short course of liposomal 
Amphotericin B. 3.2g= 13 days of treatment assuming a d aily dose of 5mg/kg x50kg. A total 
dose of 3.2g Amphotercin B desoxycholate would appear more appropriate. Was there no 
subsequent treatment with an oral azole drug? This striking feature has to be addressed and 
commented.  
 
Discussion part:  
 
- the authors  summarize some epidemiological aspects of clinical issues regarding intestinal 
mucormycosis. Somewhat worrisome apprears the fact, that some sentences are literally copied 
from previous articles: e.g. "The successful management of mucormycosis requires 1.  early 
diagnosis, 2. .....(page 7, 46ff)"  in Martinello et al, Medical Mycology Case Reports 1 (2012)52 -
55. Rephrasing might appear appropriate.  
 
- I suggest abridging the citation of general facts about mucormycosis and instead adding a 
paragraph discussi ng the important features of the present case, i.e. association with alcohol / 
liver disease and the benign course of disease  
 
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the nece ssary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess a ny statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Not suitable for publication unless extensively edited  
 
 
 
 
 
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in t he past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisatio n that may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fe es, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interes ts 
 
I agree to the open peer review policy of the jou rnal. I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for  my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: Invasive intestinal Mucormycosis in a 40 -year old immunocompetent patient ⸻ a rarely 
reported clinical phenomenon: A case report  
 
Version: 0 Date: 18 Oct 2019  
 
Reviewer: Philipp Emanuel Kaiser  
 
Reviewer's report:  
 
Abdi et al present a case of invasive mucormycosis in patient lacking classical risk factors f or 
invasive fungal disease but alcoholism and most probably alcoholic liver cirrhosis. Similar cases 
have been published before, nonetheless the existance of such cases appears noteworthy.  
 
However, the report in its current form is not suitable for publica tion. Obviously language -
related issues need to be addressed (grammatical, orthographical as well as idiomatical). 
Furthermore several content -related points have to be clarified:  
 
 
Case presentation:  
 
- was the patient in septic shock at presentation?  
 
- was he manourished?  
 
- the authors mention icterus and hyperbilirubinemia. Is there overt liver disease? (CT and 
sonography suggest cirrhosis)  
 
- pathognomonic of zygomycete fungal infection are broad thin -walled nonseptate hyphae that 
branch at right angels (wording!), which can be discerned on the histological photographs. If 
available a picture showing angioinvasion should be included.  
 
- the patient underwent laparatomy for cholecystectomy: Was the diagnosis "cholecystitis" 
proven? Were histologic studies done on the gall bladder? Intraoperative findings: colonic 
adhesions?  
 
- Most striking in this case is its benign course and good outcome: As stated in the manuscript 
intestinal has a high mortality and is often only diagnosed histologically after resectio n of 
necrotic parts of the intestine. Although the patient had systemical signs of infection, the alleged 
angioinvasive infection healed without surgery and after a extremely short course of liposomal 
Amphotericin B. 3.2g= 13 days of treatment assuming a d aily dose of 5mg/kg x50kg. A total 
dose of 3.2g Amphotercin B desoxycholate would appear more appropriate. Was there no 
subsequent treatment with an oral azole drug? This striking feature has to be addressed and 
commented.  
 
Discussion part:  
 
- the authors  summarize some epidemiological aspects of clinical issues regarding intestinal 
mucormycosis. Somewhat worrisome apprears the fact, that some sentences are literally copied 
from previous articles: e.g. "The successful management of mucormycosis requires 1.  early 
diagnosis, 2. .....(page 7, 46ff)"  in Martinello et al, Medical Mycology Case Reports 1 (2012)52 -
55. Rephrasing might appear appropriate.  
 
- I suggest abridging the citation of general facts about mucormycosis and instead adding a 
paragraph discussi ng the important features of the present case, i.e. association with alcohol / 
liver disease and the benign course of disease  
 
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the nece ssary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess a ny statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Not suitable for publication unless extensively edited  
 
 
 
 
 
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in t he past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisatio n that may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fe es, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interes ts 
 
I agree to the open peer review policy of the jou rnal. I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for  my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: Invasive intestinal Mucormycosis in a 40 -year old immunocompetent patient ⸻ a rarely 
reported clinical phenomenon: A case report  
 
Version: 0 Date: 18 Oct 2019  
 
Reviewer: Philipp Emanuel Kaiser  
 
Reviewer's report:  
 
Abdi et al present a case of invasive mucormycosis in patient lacking classical risk factors f or 
invasive fungal disease but alcoholism and most probably alcoholic liver cirrhosis. Similar cases 
have been published before, nonetheless the existance of such cases appears noteworthy.  
 
However, the report in its current form is not suitable for publica tion. Obviously language -
related issues need to be addressed (grammatical, orthographical as well as idiomatical). 
Furthermore several content -related points have to be clarified:  
 
 
Case presentation:  
 
- was the patient in septic shock at presentation?  
 
- was he manourished?  
 
- the authors mention icterus and hyperbilirubinemia. Is there overt liver disease? (CT and 
sonography suggest cirrhosis)  
 
- pathognomonic of zygomycete fungal infection are broad thin -walled nonseptate hyphae that 
branch at right angels (wording!), which can be discerned on the histological photographs. If 
available a picture showing angioinvasion should be included.  
 
- the patient underwent laparatomy for cholecystectomy: Was the diagnosis "cholecystitis" 
proven? Were histologic studies done on the gall bladder? Intraoperative findings: colonic 
adhesions?  
 
- Most striking in this case is its benign course and good outcome: As stated in the manuscript 
intestinal has a high mortality and is often only diagnosed histologically after resectio n of 
necrotic parts of the intestine. Although the patient had systemical signs of infection, the alleged 
angioinvasive infection healed without surgery and after a extremely short course of liposomal 
Amphotericin B. 3.2g= 13 days of treatment assuming a d aily dose of 5mg/kg x50kg. A total 
dose of 3.2g Amphotercin B desoxycholate would appear more appropriate. Was there no 
subsequent treatment with an oral azole drug? This striking feature has to be addressed and 
commented.  
 
Discussion part:  
 
- the authors  summarize some epidemiological aspects of clinical issues regarding intestinal 
mucormycosis. Somewhat worrisome apprears the fact, that some sentences are literally copied 
from previous articles: e.g. "The successful management of mucormycosis requires 1.  early 
diagnosis, 2. .....(page 7, 46ff)"  in Martinello et al, Medical Mycology Case Reports 1 (2012)52 -
55. Rephrasing might appear appropriate.  
 
- I suggest abridging the citation of general facts about mucormycosis and instead adding a 
paragraph discussi ng the important features of the present case, i.e. association with alcohol / 
liver disease and the benign course of disease  
 
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the nece ssary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess a ny statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Not suitable for publication unless extensively edited  
 
 
 
 
 
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in t he past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisatio n that may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fe es, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interes ts 
 
I agree to the open peer review policy of the jou rnal. I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for  my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant