Reviewer’s report
Title: 
Mucormycosis Causing Massive Lower Gastrointestinal Bleeding: A Case
Report
Version: 
0 
Date: 
13 Apr 2021
Reviewer's report:
PEER REVIEWER ASSESSMENTS: 
RELEVANCE - Does this case report make a contribution to medical
knowledge, have educational value, or highlight the need for a change in clinical
practice or diagnostic/prognostic approaches? 
Yes, this report contributes to medical knowledge
CASE DESCRIPTION - Are the details of the case sufficiently well described to
understand the patient's symptoms and course of treatment? 
Yes, the description of the case is sufficient
DIAGNOSIS/INTERPRETATION - Based on the facts presented, are the
diagnosis, interpretation, and course of treatment medically sound?
Yes, the work described is medically sound
DISCUSSION OF THE CASE - Does the discussion appropriately analyse the
importance of the findings and their relevance to future understanding of disease
processes, diagnosis or treatment? Has an adequate literature review pertinent to
the case been included?
Yes, the case is discussed fully in the context of the literature
OVERALL MANUSCRIPT POTENTIAL - Could an appropriately REVISED
version of this work represent a technically sound contribution?
Probably - with minor revisions
PEER REVIEWER COMMENTS: 
GENERAL COMMENTS: What is your overall impression of the report? 
This is a rare presentation of mucormycosis but in immunocompromised patients
maybe it should take a more prominent t role in the differential diagnosis of Gi
symptoms. Therefore this is a great learning case for hospital physicians, the
literature review and discussion is really quite good and focused
Are you confident in the authors' description and interpretation of the report? 
Yes the case is well described 
Have the authors clearly outlined the need for publication by novelty of the case
or the specific adverse event? 
The novelty of the case presentation and the excellent literature
review/discussion are very positive aspects of this journey usual case report
REQUESTED REVISIONS: 
Suggested changes 
1. Line 59 you provide a reference for the other infectious causes but not for
mucoycosis. Why? Without a reference the reader may think there are no papers
I would add at least one reference
2. This is also pertinent on the next paragraph where you really do need a few
references in the first sentence lines 65-66 and in the second sentence lines 67-
78 and line 79 because you are referring to discrete complications.
3. Line 85 was his arterial ph really 6.6? That is incredibly hard to believe-sorry
if this was a venous ph I would leave it out. 
4. Line 88 I am most used to lactate levels reported as mmol/L 
5 lines 157-158. Why would your suspect mucomucosis ? In what clinical
situations? While I understand why if you did suspect it that prophylactic anti
fungal treatment is indicated BUT what are the clinical signs that would lead you
to suspect it? Findings on colonoscopy or UGI endoscopy? When I look at lines
179-181 to treat every immunocompromised patient with lower GI bleeding with
anti fungal meds seems a bit far fetched
6. Line 144 how long did the pathology report take to come back after the
colonoscopy?
7. Lines 105-106 did you do a colonic prep? If not why did you wait until the
next day with such a massive bleed?
ADDITIONAL REQUESTS/SUGGESTIONS: 
see above
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons after the final decision on the manuscript has been made. If you have
already registered at Publons, they will notify you of the receipt of this review
and update your profile 
as per your settings and their policy. If you are not
registered with Publons, you will receive an email from them asking you to
register in order for them to be able to recognize your review on your new
profile page. Publons may use the Review Data to generate derivative metadata
for the benefit of Publons and you as a reviewer, carefully considering the
sensitivity of such information. For example, Publons may verify your record as
a reviewer by updating your profile published on its webservice if you have
registered for such service or help editors to identify candidate reviewers. Please
find the details of processing in Publons’ privacy policy
https://publons.com/about/terms
No
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 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 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 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.
This reviewer has been recruited by a partner organization, Research Square.
Reviewers with declared or apparent competing interests are not utilized for
these reviews. This reviewer has agreed to publication of their comments online
under a Creative Commons Attribution License attributed to Research Square
and was paid a small honorarium for completing the review within a specified
timeframe. Honoraria for reviews such as this are paid regardless of the reviewer
recommendation.
Reviewer Publication Consent.
 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
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the
editorial office before completing the review.
If you wish, you can include your
name in your published report. Please note you must decide whether to include
your name at the start of the process and confirm this decision whenever
prompted. If you change your decision later, we will not be able to publish your
name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
No
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Reviewer’s report
Title: 
Mucormycosis Causing Massive Lower Gastrointestinal Bleeding: A Case
Report
Version: 
0 
Date: 
13 Apr 2021
Reviewer's report:
PEER REVIEWER ASSESSMENTS: 
RELEVANCE - Does this case report make a contribution to medical
knowledge, have educational value, or highlight the need for a change in clinical
practice or diagnostic/prognostic approaches? 
Yes, this report contributes to medical knowledge
CASE DESCRIPTION - Are the details of the case sufficiently well described to
understand the patient's symptoms and course of treatment? 
Yes, the description of the case is sufficient
DIAGNOSIS/INTERPRETATION - Based on the facts presented, are the
diagnosis, interpretation, and course of treatment medically sound?
Yes, the work described is medically sound
DISCUSSION OF THE CASE - Does the discussion appropriately analyse the
importance of the findings and their relevance to future understanding of disease
processes, diagnosis or treatment? Has an adequate literature review pertinent to
the case been included?
Yes, the case is discussed fully in the context of the literature
OVERALL MANUSCRIPT POTENTIAL - Could an appropriately REVISED
version of this work represent a technically sound contribution?
Probably - with minor revisions
PEER REVIEWER COMMENTS: 
GENERAL COMMENTS: What is your overall impression of the report? 
This is a rare presentation of mucormycosis but in immunocompromised patients
maybe it should take a more prominent t role in the differential diagnosis of Gi
symptoms. Therefore this is a great learning case for hospital physicians, the
literature review and discussion is really quite good and focused
Are you confident in the authors' description and interpretation of the report? 
Yes the case is well described 
Have the authors clearly outlined the need for publication by novelty of the case
or the specific adverse event? 
The novelty of the case presentation and the excellent literature
review/discussion are very positive aspects of this journey usual case report
REQUESTED REVISIONS: 
Suggested changes 
1. Line 59 you provide a reference for the other infectious causes but not for
mucoycosis. Why? Without a reference the reader may think there are no papers
I would add at least one reference
2. This is also pertinent on the next paragraph where you really do need a few
references in the first sentence lines 65-66 and in the second sentence lines 67-
78 and line 79 because you are referring to discrete complications.
3. Line 85 was his arterial ph really 6.6? That is incredibly hard to believe-sorry
if this was a venous ph I would leave it out. 
4. Line 88 I am most used to lactate levels reported as mmol/L 
5 lines 157-158. Why would your suspect mucomucosis ? In what clinical
situations? While I understand why if you did suspect it that prophylactic anti
fungal treatment is indicated BUT what are the clinical signs that would lead you
to suspect it? Findings on colonoscopy or UGI endoscopy? When I look at lines
179-181 to treat every immunocompromised patient with lower GI bleeding with
anti fungal meds seems a bit far fetched
6. Line 144 how long did the pathology report take to come back after the
colonoscopy?
7. Lines 105-106 did you do a colonic prep? If not why did you wait until the
next day with such a massive bleed?
ADDITIONAL REQUESTS/SUGGESTIONS: 
see above
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons after the final decision on the manuscript has been made. If you have
already registered at Publons, they will notify you of the receipt of this review
and update your profile 
as per your settings and their policy. If you are not
registered with Publons, you will receive an email from them asking you to
register in order for them to be able to recognize your review on your new
profile page. Publons may use the Review Data to generate derivative metadata
for the benefit of Publons and you as a reviewer, carefully considering the
sensitivity of such information. For example, Publons may verify your record as
a reviewer by updating your profile published on its webservice if you have
registered for such service or help editors to identify candidate reviewers. Please
find the details of processing in Publons’ privacy policy
https://publons.com/about/terms
No
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 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 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 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.
This reviewer has been recruited by a partner organization, Research Square.
Reviewers with declared or apparent competing interests are not utilized for
these reviews. This reviewer has agreed to publication of their comments online
under a Creative Commons Attribution License attributed to Research Square
and was paid a small honorarium for completing the review within a specified
timeframe. Honoraria for reviews such as this are paid regardless of the reviewer
recommendation.
Reviewer Publication Consent.
 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
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the
editorial office before completing the review.
If you wish, you can include your
name in your published report. Please note you must decide whether to include
your name at the start of the process and confirm this decision whenever
prompted. If you change your decision later, we will not be able to publish your
name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
No
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Please review this paper.
user
Reviewer’s report
Title: 
Mucormycosis Causing Massive Lower Gastrointestinal Bleeding: A Case
Report
Version: 
0 
Date: 
13 Apr 2021
Reviewer's report:
PEER REVIEWER ASSESSMENTS: 
RELEVANCE - Does this case report make a contribution to medical
knowledge, have educational value, or highlight the need for a change in clinical
practice or diagnostic/prognostic approaches? 
Yes, this report contributes to medical knowledge
CASE DESCRIPTION - Are the details of the case sufficiently well described to
understand the patient's symptoms and course of treatment? 
Yes, the description of the case is sufficient
DIAGNOSIS/INTERPRETATION - Based on the facts presented, are the
diagnosis, interpretation, and course of treatment medically sound?
Yes, the work described is medically sound
DISCUSSION OF THE CASE - Does the discussion appropriately analyse the
importance of the findings and their relevance to future understanding of disease
processes, diagnosis or treatment? Has an adequate literature review pertinent to
the case been included?
Yes, the case is discussed fully in the context of the literature
OVERALL MANUSCRIPT POTENTIAL - Could an appropriately REVISED
version of this work represent a technically sound contribution?
Probably - with minor revisions
PEER REVIEWER COMMENTS: 
GENERAL COMMENTS: What is your overall impression of the report? 
This is a rare presentation of mucormycosis but in immunocompromised patients
maybe it should take a more prominent t role in the differential diagnosis of Gi
symptoms. Therefore this is a great learning case for hospital physicians, the
literature review and discussion is really quite good and focused
Are you confident in the authors' description and interpretation of the report? 
Yes the case is well described 
Have the authors clearly outlined the need for publication by novelty of the case
or the specific adverse event? 
The novelty of the case presentation and the excellent literature
review/discussion are very positive aspects of this journey usual case report
REQUESTED REVISIONS: 
Suggested changes 
1. Line 59 you provide a reference for the other infectious causes but not for
mucoycosis. Why? Without a reference the reader may think there are no papers
I would add at least one reference
2. This is also pertinent on the next paragraph where you really do need a few
references in the first sentence lines 65-66 and in the second sentence lines 67-
78 and line 79 because you are referring to discrete complications.
3. Line 85 was his arterial ph really 6.6? That is incredibly hard to believe-sorry
if this was a venous ph I would leave it out. 
4. Line 88 I am most used to lactate levels reported as mmol/L 
5 lines 157-158. Why would your suspect mucomucosis ? In what clinical
situations? While I understand why if you did suspect it that prophylactic anti
fungal treatment is indicated BUT what are the clinical signs that would lead you
to suspect it? Findings on colonoscopy or UGI endoscopy? When I look at lines
179-181 to treat every immunocompromised patient with lower GI bleeding with
anti fungal meds seems a bit far fetched
6. Line 144 how long did the pathology report take to come back after the
colonoscopy?
7. Lines 105-106 did you do a colonic prep? If not why did you wait until the
next day with such a massive bleed?
ADDITIONAL REQUESTS/SUGGESTIONS: 
see above
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons after the final decision on the manuscript has been made. If you have
already registered at Publons, they will notify you of the receipt of this review
and update your profile 
as per your settings and their policy. If you are not
registered with Publons, you will receive an email from them asking you to
register in order for them to be able to recognize your review on your new
profile page. Publons may use the Review Data to generate derivative metadata
for the benefit of Publons and you as a reviewer, carefully considering the
sensitivity of such information. For example, Publons may verify your record as
a reviewer by updating your profile published on its webservice if you have
registered for such service or help editors to identify candidate reviewers. Please
find the details of processing in Publons’ privacy policy
https://publons.com/about/terms
No
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 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 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 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.
This reviewer has been recruited by a partner organization, Research Square.
Reviewers with declared or apparent competing interests are not utilized for
these reviews. This reviewer has agreed to publication of their comments online
under a Creative Commons Attribution License attributed to Research Square
and was paid a small honorarium for completing the review within a specified
timeframe. Honoraria for reviews such as this are paid regardless of the reviewer
recommendation.
Reviewer Publication Consent.
 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
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the
editorial office before completing the review.
If you wish, you can include your
name in your published report. Please note you must decide whether to include
your name at the start of the process and confirm this decision whenever
prompted. If you change your decision later, we will not be able to publish your
name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
No
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
assistant