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: 25 Oct 2019  
 
Reviewer: Eileen Benz  
 
Reviewer's report:  
 
Summary:  
 
The authors have submitted a case report of invasive intestinal mucormycosis in an 
immunocompetent patient. This is somewhat interesting as this often life threatening fungal 
infection has more often been described in immunocompromised patients, and accord ing to the 
literature presents less frequently with gastro -intestinal involvement. Although gastrointestinal 
mucormycosis usually carries a high mortality, this patient has been successfully treated with 
medical management without need for surgical interve ntion. However, several major revisions 
(details below) should be undertaken by the authors before re -submission of this manuscript for 
publication.  
 
 
Major revisions:  
 
1. I believe that the level of written English of this manuscript is not sufficient for a  case report 
to be published in this journal. There are several errors of grammar, as well as syntax, spelling, 
and appropriate choice of words in most sections of the manuscript, including the abstract. I 
therefore suggest a thorough revision of the docum ent regarding these.  
 
 
2. In the first paragraph of the section "case presentation"(p.3), several laboratory results are 
presented without corresponding units (for example the results of the liver function tests). 
Furthermore, the laboratory reference range should also be indicated for each laboratory result.  
 
 
3. I would appreciate a more detailed presentation of relevant past medical history as well as 
some more contextual information (travel history, occupational history, contact with animals, 
contact with o ther people presenting with similar symptoms etc.) as these may give important 
clues for diagnosis, especially in suspected infectious disease.  
 
 
4. Although the results of several investigations (laboratory results, imaging, endoscopy) are 
described (p.3 -4), there is no further comment regarding diagnostic reasoning and differential 
diagnoses that may have been considered at each stage of the work -up. I would suggest including 
these in the revised manuscript as they might give more insight of how this case w as 
investigated.  
 
 
5. Regarding therapeutics, I would appreciate a more detailed description of the treatment which 
the patient received after being discharged from the in -patient setting (i.e dose and duration of 
the out -patient treatment).  
 
 
6. I would appre ciate a short discussion on the strengths and limitations of the authors' approach 
to this case.  
 
 
Minor revisions:  
 
1. Regarding the description of the images in Figure 2 (p.5) it is unclear what the black arrows 
exactly indicate. I would suggest a more pre cise description.  
 
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Unable to assess  
 
Does the work include the nece ssary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
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: 25 Oct 2019  
 
Reviewer: Eileen Benz  
 
Reviewer's report:  
 
Summary:  
 
The authors have submitted a case report of invasive intestinal mucormycosis in an 
immunocompetent patient. This is somewhat interesting as this often life threatening fungal 
infection has more often been described in immunocompromised patients, and accord ing to the 
literature presents less frequently with gastro -intestinal involvement. Although gastrointestinal 
mucormycosis usually carries a high mortality, this patient has been successfully treated with 
medical management without need for surgical interve ntion. However, several major revisions 
(details below) should be undertaken by the authors before re -submission of this manuscript for 
publication.  
 
 
Major revisions:  
 
1. I believe that the level of written English of this manuscript is not sufficient for a  case report 
to be published in this journal. There are several errors of grammar, as well as syntax, spelling, 
and appropriate choice of words in most sections of the manuscript, including the abstract. I 
therefore suggest a thorough revision of the docum ent regarding these.  
 
 
2. In the first paragraph of the section "case presentation"(p.3), several laboratory results are 
presented without corresponding units (for example the results of the liver function tests). 
Furthermore, the laboratory reference range should also be indicated for each laboratory result.  
 
 
3. I would appreciate a more detailed presentation of relevant past medical history as well as 
some more contextual information (travel history, occupational history, contact with animals, 
contact with o ther people presenting with similar symptoms etc.) as these may give important 
clues for diagnosis, especially in suspected infectious disease.  
 
 
4. Although the results of several investigations (laboratory results, imaging, endoscopy) are 
described (p.3 -4), there is no further comment regarding diagnostic reasoning and differential 
diagnoses that may have been considered at each stage of the work -up. I would suggest including 
these in the revised manuscript as they might give more insight of how this case w as 
investigated.  
 
 
5. Regarding therapeutics, I would appreciate a more detailed description of the treatment which 
the patient received after being discharged from the in -patient setting (i.e dose and duration of 
the out -patient treatment).  
 
 
6. I would appre ciate a short discussion on the strengths and limitations of the authors' approach 
to this case.  
 
 
Minor revisions:  
 
1. Regarding the description of the images in Figure 2 (p.5) it is unclear what the black arrows 
exactly indicate. I would suggest a more pre cise description.  
 
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Unable to assess  
 
Does the work include the nece ssary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
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: 25 Oct 2019  
 
Reviewer: Eileen Benz  
 
Reviewer's report:  
 
Summary:  
 
The authors have submitted a case report of invasive intestinal mucormycosis in an 
immunocompetent patient. This is somewhat interesting as this often life threatening fungal 
infection has more often been described in immunocompromised patients, and accord ing to the 
literature presents less frequently with gastro -intestinal involvement. Although gastrointestinal 
mucormycosis usually carries a high mortality, this patient has been successfully treated with 
medical management without need for surgical interve ntion. However, several major revisions 
(details below) should be undertaken by the authors before re -submission of this manuscript for 
publication.  
 
 
Major revisions:  
 
1. I believe that the level of written English of this manuscript is not sufficient for a  case report 
to be published in this journal. There are several errors of grammar, as well as syntax, spelling, 
and appropriate choice of words in most sections of the manuscript, including the abstract. I 
therefore suggest a thorough revision of the docum ent regarding these.  
 
 
2. In the first paragraph of the section "case presentation"(p.3), several laboratory results are 
presented without corresponding units (for example the results of the liver function tests). 
Furthermore, the laboratory reference range should also be indicated for each laboratory result.  
 
 
3. I would appreciate a more detailed presentation of relevant past medical history as well as 
some more contextual information (travel history, occupational history, contact with animals, 
contact with o ther people presenting with similar symptoms etc.) as these may give important 
clues for diagnosis, especially in suspected infectious disease.  
 
 
4. Although the results of several investigations (laboratory results, imaging, endoscopy) are 
described (p.3 -4), there is no further comment regarding diagnostic reasoning and differential 
diagnoses that may have been considered at each stage of the work -up. I would suggest including 
these in the revised manuscript as they might give more insight of how this case w as 
investigated.  
 
 
5. Regarding therapeutics, I would appreciate a more detailed description of the treatment which 
the patient received after being discharged from the in -patient setting (i.e dose and duration of 
the out -patient treatment).  
 
 
6. I would appre ciate a short discussion on the strengths and limitations of the authors' approach 
to this case.  
 
 
Minor revisions:  
 
1. Regarding the description of the images in Figure 2 (p.5) it is unclear what the black arrows 
exactly indicate. I would suggest a more pre cise description.  
 
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Unable to assess  
 
Does the work include the nece ssary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
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