Reviewer's report
Title:Multiple aseptic splenic abscesses in a 15 year old patient - role of
anaerobic bacteria?
Version:3Date:10 December 2013
Reviewer: Maria Tsolia
Reviewer's report:
The authors describe the case of a 15-year old adolescent girl with multiple
aseptic splenic abscesses without Crohn’ s disease. Although there was some
improvement in patient’s symptoms after administration of antibiotics such as
meropenem and metronidazole complete resolution of the abscesses was
achieved only with corticosteroid treatment.
This is a nice case report describing a rare clinical entity since there are only
scarce similar reports in the literature. Physicians must be able to recognize this
disease which requires immunosuppressive treatment.
The possible role of anti- anaerobic treatment, namely metronidazole, is raised
since there was some initial response to the combination of meropenem and
metronidazole including healing of accompanying pharyngeal ulcers and
improvement of inflammatory markers. However, there was no effect on abscess
size and number which increased upon discharge and new ones developed only
to resolve after administration of prednisone in combination with metronidazole.
Comments
Minor essential revisions
1. Although it its evident that the disease was controlled only after corticosteroid
treatment the role of metronidazole is less clear. The improvement detected after
initial treatment with meropenem and metronidazole should be described in more
detail (resolution of fever? How improved were the inflammatory markers on
initial discharge?). Did the patient receive any antibiotics upon discharge the first
time?. In addition, no conclusions can be drawn about the contribution of
metronidazole to disease resolution since it was administered together with
prednisone.
2. Follow-up time: was it enough to detect Crohn’ s disease? How long after the
development of abscesses did Crohn’s disease manifest in the published
reports?
3. Some spelling errors need to be corrected: an-/hypoechoic (un-/hypoechoic),
Clindamycine (clindamycin), quantiferone (Quantiferon test), thyreoiditis
(thyroiditis)
Discretional revisions
4. It would be useful if the authors could briefly summarize the cases previously
described in the literature among children (if any) and adolescents as well their
clinical and laboratory characteristics.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
I declare that I have no competing interests
Reviewer's report
Title:Multiple aseptic splenic abscesses in a 15 year old patient - role of
anaerobic bacteria?
Version:3Date:10 December 2013
Reviewer: Maria Tsolia
Reviewer's report:
The authors describe the case of a 15-year old adolescent girl with multiple
aseptic splenic abscesses without Crohn’ s disease. Although there was some
improvement in patient’s symptoms after administration of antibiotics such as
meropenem and metronidazole complete resolution of the abscesses was
achieved only with corticosteroid treatment.
This is a nice case report describing a rare clinical entity since there are only
scarce similar reports in the literature. Physicians must be able to recognize this
disease which requires immunosuppressive treatment.
The possible role of anti- anaerobic treatment, namely metronidazole, is raised
since there was some initial response to the combination of meropenem and
metronidazole including healing of accompanying pharyngeal ulcers and
improvement of inflammatory markers. However, there was no effect on abscess
size and number which increased upon discharge and new ones developed only
to resolve after administration of prednisone in combination with metronidazole.
Comments
Minor essential revisions
1. Although it its evident that the disease was controlled only after corticosteroid
treatment the role of metronidazole is less clear. The improvement detected after
initial treatment with meropenem and metronidazole should be described in more
detail (resolution of fever? How improved were the inflammatory markers on
initial discharge?). Did the patient receive any antibiotics upon discharge the first
time?. In addition, no conclusions can be drawn about the contribution of
metronidazole to disease resolution since it was administered together with
prednisone.
2. Follow-up time: was it enough to detect Crohn’ s disease? How long after the
development of abscesses did Crohn’s disease manifest in the published
reports?
3. Some spelling errors need to be corrected: an-/hypoechoic (un-/hypoechoic),
Clindamycine (clindamycin), quantiferone (Quantiferon test), thyreoiditis
(thyroiditis)
Discretional revisions
4. It would be useful if the authors could briefly summarize the cases previously
described in the literature among children (if any) and adolescents as well their
clinical and laboratory characteristics.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
I declare that I have no competing interests
Please review this paper.
user
Reviewer's report
Title:Multiple aseptic splenic abscesses in a 15 year old patient - role of
anaerobic bacteria?
Version:3Date:10 December 2013
Reviewer: Maria Tsolia
Reviewer's report:
The authors describe the case of a 15-year old adolescent girl with multiple
aseptic splenic abscesses without Crohn’ s disease. Although there was some
improvement in patient’s symptoms after administration of antibiotics such as
meropenem and metronidazole complete resolution of the abscesses was
achieved only with corticosteroid treatment.
This is a nice case report describing a rare clinical entity since there are only
scarce similar reports in the literature. Physicians must be able to recognize this
disease which requires immunosuppressive treatment.
The possible role of anti- anaerobic treatment, namely metronidazole, is raised
since there was some initial response to the combination of meropenem and
metronidazole including healing of accompanying pharyngeal ulcers and
improvement of inflammatory markers. However, there was no effect on abscess
size and number which increased upon discharge and new ones developed only
to resolve after administration of prednisone in combination with metronidazole.
Comments
Minor essential revisions
1. Although it its evident that the disease was controlled only after corticosteroid
treatment the role of metronidazole is less clear. The improvement detected after
initial treatment with meropenem and metronidazole should be described in more
detail (resolution of fever? How improved were the inflammatory markers on
initial discharge?). Did the patient receive any antibiotics upon discharge the first
time?. In addition, no conclusions can be drawn about the contribution of
metronidazole to disease resolution since it was administered together with
prednisone.
2. Follow-up time: was it enough to detect Crohn’ s disease? How long after the
development of abscesses did Crohn’s disease manifest in the published
reports?
3. Some spelling errors need to be corrected: an-/hypoechoic (un-/hypoechoic),
Clindamycine (clindamycin), quantiferone (Quantiferon test), thyreoiditis
(thyroiditis)
Discretional revisions
4. It would be useful if the authors could briefly summarize the cases previously
described in the literature among children (if any) and adolescents as well their
clinical and laboratory characteristics.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
I declare that I have no competing interests
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