Reviewer ’s report  
 
Title: Successful Treatment of Pyoderma Gangrenosum in a Patient with A utoimmune 
Hepatitis.A  case report and review of the literature.  
 
Version: 0 Date: 25 Aug 2015  
 
Reviewer: Marco Carbone  
 
Reviewer ’s report:  
 
This case report, despite not unique, is interesting since add evidences of a clinical association 
between Pyoderma Gangrenosum (PG) and Autoimmune Hepatitis (AIH) and might suggest 
shared immunological pat hways between the two diseases.  
 
 
Major comments:  
 
The case report should not try to prove causation but only an association between the two 
diseases. The conclusion should focus on what has been learned from the case report and should 
not offer unsupported statements. Authors are invited to provide hypoth eses regarding the 
significance of the case and some suggestions for future inquiry into the topic. Reference list 
should be improved as suggest in the appropriate section below.  
 
 
Minor comments:  
 
- The main text should be organized as 'background, case pre sentation and conclusions' (no 
discussion sect ion) as per Journal guidelines.  
 
 
ABSTRACT:  
 
- Case presentation (Line 32, page 3): It is suggested not to start a sentence with a number. Make 
it "One year after the initiation…" rather than "1 year after the in itiation…".  
 
- Conclusion (Line 36, page 3): "With this case report we describe an unusual presentation of 
autoimmune hepatitis, in the form of pyoderma gangrenosum". Strictly speaking it is not a 
presentation of AIH (since AIH was already present at the t ime of PG onset). Also, this case 
report does not prove causation but only an association between the two diseases.  
 
 
CASE PRESENTATION  
 
- Line 14, page 5: It might be worth to describe more detailed clinical information on the AIH, 
e.g. biochemical activity , histological grading and staging of disease at diagnosis and at the time 
of the PG onset; and therapy of AIH at the time of PG onset.  
 
- Line 6, page 6: Details on liver histology may be beneficial for the reader.  
 
 
DISCUSSION  
 
- Line 28, page 6: This para graph is unnecessary: "In 1950 Waldenström reported a series of 
young women with a severe form of fluctuating hepatitis that was identified as a separate clinical 
entity, initially under the name of "chronic active autoimmune hepatitis" and subsequently as  
"autoimmune hepatitis," attesting to the variable presence of disease activity [16, 17]." It is 
suggested to remove and replace it with a definition of AIH.  
 
- Line 6, page 7: reference 3,8 and 9 are not appropriately placed. References on literature rela ted 
to extrahepatic autoimmune diseases associated with AIH 1 and 2 should be reported.  
 
 
CONCLUSIONS:  
 
- Line 57, page 7: "…proving that the above mentioned treatment can be effective for both 
diseases". This statement is not correct. The AIH was in remissi on before the PG onset and the 
treatment for PG did not affect  clinically the disease course.  
 
 
REFERENCES  
 
- Add additional case report on PG and AIH: Wat H, Haber RM. J Cutan Med Surg. 2014 Sep -
Oct;18(5):345 -52. Trends in the Association between Pyoderma  Gangrenosum and Autoimmune 
Hepatitis: Case Report and Review of the Literature.  
 
- The only reference on AIH is Vergani D, Longhi MS, Bogdanos DP, Ma Y, Mieli -Vergani G.  
Autoimmune hepatitis .Semin Immunopathol 2009.  I suggest to use more recent literature. Just 
as suggestion there is a review on AIH just published (Manns MP, Lohse AW, Vergani D. 
Autoimmune hepatitis -Update 2015. J Hepatol. 2015 Apr;62(1 Suppl):S100 -11. d oi: 
10.1016/j.jhep.2015.03.005).  
 
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 necessary controls?  
If not, please  specify which controls are required in your comments to the authors.  
 
Unable to asses  
 
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 any statistics in th e 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 wri tten English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received rei mbursements, 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 organisation 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 o f the  
manuscript?  
 
4. Have you received reimbursements, fees, 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 i nterests  
 
I agree to the open peer review policy of the journal. 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: Successful Treatment of Pyoderma Gangrenosum in a Patient with A utoimmune 
Hepatitis.A  case report and review of the literature.  
 
Version: 0 Date: 25 Aug 2015  
 
Reviewer: Marco Carbone  
 
Reviewer ’s report:  
 
This case report, despite not unique, is interesting since add evidences of a clinical association 
between Pyoderma Gangrenosum (PG) and Autoimmune Hepatitis (AIH) and might suggest 
shared immunological pat hways between the two diseases.  
 
 
Major comments:  
 
The case report should not try to prove causation but only an association between the two 
diseases. The conclusion should focus on what has been learned from the case report and should 
not offer unsupported statements. Authors are invited to provide hypoth eses regarding the 
significance of the case and some suggestions for future inquiry into the topic. Reference list 
should be improved as suggest in the appropriate section below.  
 
 
Minor comments:  
 
- The main text should be organized as 'background, case pre sentation and conclusions' (no 
discussion sect ion) as per Journal guidelines.  
 
 
ABSTRACT:  
 
- Case presentation (Line 32, page 3): It is suggested not to start a sentence with a number. Make 
it "One year after the initiation…" rather than "1 year after the in itiation…".  
 
- Conclusion (Line 36, page 3): "With this case report we describe an unusual presentation of 
autoimmune hepatitis, in the form of pyoderma gangrenosum". Strictly speaking it is not a 
presentation of AIH (since AIH was already present at the t ime of PG onset). Also, this case 
report does not prove causation but only an association between the two diseases.  
 
 
CASE PRESENTATION  
 
- Line 14, page 5: It might be worth to describe more detailed clinical information on the AIH, 
e.g. biochemical activity , histological grading and staging of disease at diagnosis and at the time 
of the PG onset; and therapy of AIH at the time of PG onset.  
 
- Line 6, page 6: Details on liver histology may be beneficial for the reader.  
 
 
DISCUSSION  
 
- Line 28, page 6: This para graph is unnecessary: "In 1950 Waldenström reported a series of 
young women with a severe form of fluctuating hepatitis that was identified as a separate clinical 
entity, initially under the name of "chronic active autoimmune hepatitis" and subsequently as  
"autoimmune hepatitis," attesting to the variable presence of disease activity [16, 17]." It is 
suggested to remove and replace it with a definition of AIH.  
 
- Line 6, page 7: reference 3,8 and 9 are not appropriately placed. References on literature rela ted 
to extrahepatic autoimmune diseases associated with AIH 1 and 2 should be reported.  
 
 
CONCLUSIONS:  
 
- Line 57, page 7: "…proving that the above mentioned treatment can be effective for both 
diseases". This statement is not correct. The AIH was in remissi on before the PG onset and the 
treatment for PG did not affect  clinically the disease course.  
 
 
REFERENCES  
 
- Add additional case report on PG and AIH: Wat H, Haber RM. J Cutan Med Surg. 2014 Sep -
Oct;18(5):345 -52. Trends in the Association between Pyoderma  Gangrenosum and Autoimmune 
Hepatitis: Case Report and Review of the Literature.  
 
- The only reference on AIH is Vergani D, Longhi MS, Bogdanos DP, Ma Y, Mieli -Vergani G.  
Autoimmune hepatitis .Semin Immunopathol 2009.  I suggest to use more recent literature. Just 
as suggestion there is a review on AIH just published (Manns MP, Lohse AW, Vergani D. 
Autoimmune hepatitis -Update 2015. J Hepatol. 2015 Apr;62(1 Suppl):S100 -11. d oi: 
10.1016/j.jhep.2015.03.005).  
 
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 necessary controls?  
If not, please  specify which controls are required in your comments to the authors.  
 
Unable to asses  
 
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 any statistics in th e 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 wri tten English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received rei mbursements, 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 organisation 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 o f the  
manuscript?  
 
4. Have you received reimbursements, fees, 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 i nterests  
 
I agree to the open peer review policy of the journal. 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: Successful Treatment of Pyoderma Gangrenosum in a Patient with A utoimmune 
Hepatitis.A  case report and review of the literature.  
 
Version: 0 Date: 25 Aug 2015  
 
Reviewer: Marco Carbone  
 
Reviewer ’s report:  
 
This case report, despite not unique, is interesting since add evidences of a clinical association 
between Pyoderma Gangrenosum (PG) and Autoimmune Hepatitis (AIH) and might suggest 
shared immunological pat hways between the two diseases.  
 
 
Major comments:  
 
The case report should not try to prove causation but only an association between the two 
diseases. The conclusion should focus on what has been learned from the case report and should 
not offer unsupported statements. Authors are invited to provide hypoth eses regarding the 
significance of the case and some suggestions for future inquiry into the topic. Reference list 
should be improved as suggest in the appropriate section below.  
 
 
Minor comments:  
 
- The main text should be organized as 'background, case pre sentation and conclusions' (no 
discussion sect ion) as per Journal guidelines.  
 
 
ABSTRACT:  
 
- Case presentation (Line 32, page 3): It is suggested not to start a sentence with a number. Make 
it "One year after the initiation…" rather than "1 year after the in itiation…".  
 
- Conclusion (Line 36, page 3): "With this case report we describe an unusual presentation of 
autoimmune hepatitis, in the form of pyoderma gangrenosum". Strictly speaking it is not a 
presentation of AIH (since AIH was already present at the t ime of PG onset). Also, this case 
report does not prove causation but only an association between the two diseases.  
 
 
CASE PRESENTATION  
 
- Line 14, page 5: It might be worth to describe more detailed clinical information on the AIH, 
e.g. biochemical activity , histological grading and staging of disease at diagnosis and at the time 
of the PG onset; and therapy of AIH at the time of PG onset.  
 
- Line 6, page 6: Details on liver histology may be beneficial for the reader.  
 
 
DISCUSSION  
 
- Line 28, page 6: This para graph is unnecessary: "In 1950 Waldenström reported a series of 
young women with a severe form of fluctuating hepatitis that was identified as a separate clinical 
entity, initially under the name of "chronic active autoimmune hepatitis" and subsequently as  
"autoimmune hepatitis," attesting to the variable presence of disease activity [16, 17]." It is 
suggested to remove and replace it with a definition of AIH.  
 
- Line 6, page 7: reference 3,8 and 9 are not appropriately placed. References on literature rela ted 
to extrahepatic autoimmune diseases associated with AIH 1 and 2 should be reported.  
 
 
CONCLUSIONS:  
 
- Line 57, page 7: "…proving that the above mentioned treatment can be effective for both 
diseases". This statement is not correct. The AIH was in remissi on before the PG onset and the 
treatment for PG did not affect  clinically the disease course.  
 
 
REFERENCES  
 
- Add additional case report on PG and AIH: Wat H, Haber RM. J Cutan Med Surg. 2014 Sep -
Oct;18(5):345 -52. Trends in the Association between Pyoderma  Gangrenosum and Autoimmune 
Hepatitis: Case Report and Review of the Literature.  
 
- The only reference on AIH is Vergani D, Longhi MS, Bogdanos DP, Ma Y, Mieli -Vergani G.  
Autoimmune hepatitis .Semin Immunopathol 2009.  I suggest to use more recent literature. Just 
as suggestion there is a review on AIH just published (Manns MP, Lohse AW, Vergani D. 
Autoimmune hepatitis -Update 2015. J Hepatol. 2015 Apr;62(1 Suppl):S100 -11. d oi: 
10.1016/j.jhep.2015.03.005).  
 
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 necessary controls?  
If not, please  specify which controls are required in your comments to the authors.  
 
Unable to asses  
 
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 any statistics in th e 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 wri tten English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received rei mbursements, 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 organisation 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 o f the  
manuscript?  
 
4. Have you received reimbursements, fees, 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 i nterests  
 
I agree to the open peer review policy of the journal. 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