Reviewer ’s report  
Title: Splenic abscesses as a first manifestation of Crohn's disease: a case report  
Version: 1 Date: 13 May 2019  
Reviewer: J. Chang  
Reviewer's report:  
This is a case report of a 21 -year-old female presenting multifocal aseptic splenic abscess as the 
earliest manifestation of Crohn disease. Splenic nodules associated with  Crohn disease have been 
reported by a few papers before. This group is the first to show splenic nodules as an initial sign 
of Crohn Disease by PET. The manuscript highlighted the importance of keeping Crohn Disease 
in the differential diagnosis due to th e extensive range of extra -intestinal manifestations. This is 
indeed an interesting manuscript. However, in my opinion, to be considered for publication, the 
authors need to address the following comments.   
 
Major comments  
1. Gross and pathology images (F igure 3 and Figure 4) are extremely blurry and do not 
meet the standard for publication. Please replace with crisp and higher resolution images, 
as well as include the magnification power in the figure legends.  
 
2. ASCA antibodies are implied to distinguis h Crohn disease from ulcerative colitis. Since 
the patient's ASCA IgG titer was positive, have you consulted gastroenterology specialist 
at that time? Would you please elaborate the contents in that consult? Please also 
incorporate ASCA positivity into you r diagnosis process.  
 
3. How long is it between the patient presented with splenic nodules and the Crohn disease 
being diagnosed? Please include this information in your case description.  
 
Minor comments  
1. Please include more explanation in the figure leg ends for Fig. 3B and Fig. 3C.  
 
2. Please replace "our hospital" and "our department" with the official name of the hospital 
and department.  
 
3. Please include proper citation for your statement in the Discussion, "Among autoimmune 
diseases … from the mouth t o the anus."  
 
4. In the Discussion section, you mentioned about four previous reports of splenic 
abscesses; however, only three papers were cited. Where is the fourth report?  
 
5. Reference formats are inconsistent. Please use the same format for all the refe rences.  
 
6. Overall, the writing style is wordy with many redundant phrases/sentences. Please seek 
professional English editing and polish the manuscript.   
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 necessary 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 any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is r ecommended, 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:  
 
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 reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financia lly 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 o r are you currently applying for any patents relating to the content of 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 yo u 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 interests  
 
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 unde r 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: Splenic abscesses as a first manifestation of Crohn's disease: a case report  
Version: 1 Date: 13 May 2019  
Reviewer: J. Chang  
Reviewer's report:  
This is a case report of a 21 -year-old female presenting multifocal aseptic splenic abscess as the 
earliest manifestation of Crohn disease. Splenic nodules associated with  Crohn disease have been 
reported by a few papers before. This group is the first to show splenic nodules as an initial sign 
of Crohn Disease by PET. The manuscript highlighted the importance of keeping Crohn Disease 
in the differential diagnosis due to th e extensive range of extra -intestinal manifestations. This is 
indeed an interesting manuscript. However, in my opinion, to be considered for publication, the 
authors need to address the following comments.   
 
Major comments  
1. Gross and pathology images (F igure 3 and Figure 4) are extremely blurry and do not 
meet the standard for publication. Please replace with crisp and higher resolution images, 
as well as include the magnification power in the figure legends.  
 
2. ASCA antibodies are implied to distinguis h Crohn disease from ulcerative colitis. Since 
the patient's ASCA IgG titer was positive, have you consulted gastroenterology specialist 
at that time? Would you please elaborate the contents in that consult? Please also 
incorporate ASCA positivity into you r diagnosis process.  
 
3. How long is it between the patient presented with splenic nodules and the Crohn disease 
being diagnosed? Please include this information in your case description.  
 
Minor comments  
1. Please include more explanation in the figure leg ends for Fig. 3B and Fig. 3C.  
 
2. Please replace "our hospital" and "our department" with the official name of the hospital 
and department.  
 
3. Please include proper citation for your statement in the Discussion, "Among autoimmune 
diseases … from the mouth t o the anus."  
 
4. In the Discussion section, you mentioned about four previous reports of splenic 
abscesses; however, only three papers were cited. Where is the fourth report?  
 
5. Reference formats are inconsistent. Please use the same format for all the refe rences.  
 
6. Overall, the writing style is wordy with many redundant phrases/sentences. Please seek 
professional English editing and polish the manuscript.   
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 necessary 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 any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is r ecommended, 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:  
 
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 reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financia lly 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 o r are you currently applying for any patents relating to the content of 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 yo u 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 interests  
 
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 unde r 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: Splenic abscesses as a first manifestation of Crohn's disease: a case report  
Version: 1 Date: 13 May 2019  
Reviewer: J. Chang  
Reviewer's report:  
This is a case report of a 21 -year-old female presenting multifocal aseptic splenic abscess as the 
earliest manifestation of Crohn disease. Splenic nodules associated with  Crohn disease have been 
reported by a few papers before. This group is the first to show splenic nodules as an initial sign 
of Crohn Disease by PET. The manuscript highlighted the importance of keeping Crohn Disease 
in the differential diagnosis due to th e extensive range of extra -intestinal manifestations. This is 
indeed an interesting manuscript. However, in my opinion, to be considered for publication, the 
authors need to address the following comments.   
 
Major comments  
1. Gross and pathology images (F igure 3 and Figure 4) are extremely blurry and do not 
meet the standard for publication. Please replace with crisp and higher resolution images, 
as well as include the magnification power in the figure legends.  
 
2. ASCA antibodies are implied to distinguis h Crohn disease from ulcerative colitis. Since 
the patient's ASCA IgG titer was positive, have you consulted gastroenterology specialist 
at that time? Would you please elaborate the contents in that consult? Please also 
incorporate ASCA positivity into you r diagnosis process.  
 
3. How long is it between the patient presented with splenic nodules and the Crohn disease 
being diagnosed? Please include this information in your case description.  
 
Minor comments  
1. Please include more explanation in the figure leg ends for Fig. 3B and Fig. 3C.  
 
2. Please replace "our hospital" and "our department" with the official name of the hospital 
and department.  
 
3. Please include proper citation for your statement in the Discussion, "Among autoimmune 
diseases … from the mouth t o the anus."  
 
4. In the Discussion section, you mentioned about four previous reports of splenic 
abscesses; however, only three papers were cited. Where is the fourth report?  
 
5. Reference formats are inconsistent. Please use the same format for all the refe rences.  
 
6. Overall, the writing style is wordy with many redundant phrases/sentences. Please seek 
professional English editing and polish the manuscript.   
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 necessary 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 any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is r ecommended, 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:  
 
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 reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financia lly 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 o r are you currently applying for any patents relating to the content of 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 yo u 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 interests  
 
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 unde r 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