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: 22 Nov 2019  
 
Reviewer: Daniela Lenggenhager  
 
Reviewer's report:  
 
Specific review of the histopathology:  
 
I agree that the fungal filaments shown in the histology figures, are "consistent with" 
zygomycetes/mucor.  Did the authors perfom any microbiological cultures or molecular testing to 
support/confirm this diagnosis?  
 
However, I do not fully agree with the description of the histopathologic findings:  
Please, consider the following changes in the text (line 30 -38): 
Histopathology report revealed an acute suppurative inflammation of the colon mucosa with 
extensive areas of necrosis and the detection of many wide, ribbon -like, sparsely septated fungal 
hyphae with wide -angle branching (approximately 90°), characteris tic of zygomycetes species 
and thus consistent with mucormycosis [Figure 3 and 4].  
 
Regarding the part: "Focal areas of infarction due to invasion of blood vessel walls were seen, 
suggesting angioinvasive mucormycosis."  
Unfortunately, on Fig. 3 and 4, I ca n't see any infarction or invasion of blood vessles (only fibrin, 
inflammation and fungal filaments).  
The manuscript would clearly benefit from an image of invasion of blood vessles and/or 
infarction (maybe in a lower magnification, e.g. x10 or x20).  
 
Please, consider the following changes in the figure legends:  
Figure 3: Colon biopsies (or if you know where the biopsies come from, please indicate: 
"Biopsies from the left/right colon or from the rectum") (hematoxylin and eosin (H &amp; E) 
stain; 100x). (A) B iopsy from the center of a mucosal ulceration with sparsely septated hyphae of 
zygomycetes (arrow) lying in fibrinous exudate. (B) Biopsy from a colon polyp with surface 
deposits of fungal filaments of zygomycetes (arrow) lying in an acute suppurative infl ammation 
exudate.  
 
Figure 4: (A) Periodic acid -Schiff (PAS) stain and (B) Gomori Methenamine -Silver stain (GMS) 
highlighting the wide, ribbon -like, sparsely septated hyphae with wide -angle branching 
(approximately 90°; arrow), characteristic of zygomycetes species.  
(You coul d add an arrow where you see the 90° branching in the lower part of the image.)  
 
Please, delete Figure 6: This does not show any colonic ulcer, active colitis or neutrophilic 
infiltration (not in A and not in B).  
Spelling:  
 
- hyphae (not: hype)  
 
- zygomyce tes (not: Zygomycetes)  
 
 
 
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.  
 
Unable to assess  
 
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 interests.  
 
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: 22 Nov 2019  
 
Reviewer: Daniela Lenggenhager  
 
Reviewer's report:  
 
Specific review of the histopathology:  
 
I agree that the fungal filaments shown in the histology figures, are "consistent with" 
zygomycetes/mucor.  Did the authors perfom any microbiological cultures or molecular testing to 
support/confirm this diagnosis?  
 
However, I do not fully agree with the description of the histopathologic findings:  
Please, consider the following changes in the text (line 30 -38): 
Histopathology report revealed an acute suppurative inflammation of the colon mucosa with 
extensive areas of necrosis and the detection of many wide, ribbon -like, sparsely septated fungal 
hyphae with wide -angle branching (approximately 90°), characteris tic of zygomycetes species 
and thus consistent with mucormycosis [Figure 3 and 4].  
 
Regarding the part: "Focal areas of infarction due to invasion of blood vessel walls were seen, 
suggesting angioinvasive mucormycosis."  
Unfortunately, on Fig. 3 and 4, I ca n't see any infarction or invasion of blood vessles (only fibrin, 
inflammation and fungal filaments).  
The manuscript would clearly benefit from an image of invasion of blood vessles and/or 
infarction (maybe in a lower magnification, e.g. x10 or x20).  
 
Please, consider the following changes in the figure legends:  
Figure 3: Colon biopsies (or if you know where the biopsies come from, please indicate: 
"Biopsies from the left/right colon or from the rectum") (hematoxylin and eosin (H &amp; E) 
stain; 100x). (A) B iopsy from the center of a mucosal ulceration with sparsely septated hyphae of 
zygomycetes (arrow) lying in fibrinous exudate. (B) Biopsy from a colon polyp with surface 
deposits of fungal filaments of zygomycetes (arrow) lying in an acute suppurative infl ammation 
exudate.  
 
Figure 4: (A) Periodic acid -Schiff (PAS) stain and (B) Gomori Methenamine -Silver stain (GMS) 
highlighting the wide, ribbon -like, sparsely septated hyphae with wide -angle branching 
(approximately 90°; arrow), characteristic of zygomycetes species.  
(You coul d add an arrow where you see the 90° branching in the lower part of the image.)  
 
Please, delete Figure 6: This does not show any colonic ulcer, active colitis or neutrophilic 
infiltration (not in A and not in B).  
Spelling:  
 
- hyphae (not: hype)  
 
- zygomyce tes (not: Zygomycetes)  
 
 
 
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.  
 
Unable to assess  
 
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 interests.  
 
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: 22 Nov 2019  
 
Reviewer: Daniela Lenggenhager  
 
Reviewer's report:  
 
Specific review of the histopathology:  
 
I agree that the fungal filaments shown in the histology figures, are "consistent with" 
zygomycetes/mucor.  Did the authors perfom any microbiological cultures or molecular testing to 
support/confirm this diagnosis?  
 
However, I do not fully agree with the description of the histopathologic findings:  
Please, consider the following changes in the text (line 30 -38): 
Histopathology report revealed an acute suppurative inflammation of the colon mucosa with 
extensive areas of necrosis and the detection of many wide, ribbon -like, sparsely septated fungal 
hyphae with wide -angle branching (approximately 90°), characteris tic of zygomycetes species 
and thus consistent with mucormycosis [Figure 3 and 4].  
 
Regarding the part: "Focal areas of infarction due to invasion of blood vessel walls were seen, 
suggesting angioinvasive mucormycosis."  
Unfortunately, on Fig. 3 and 4, I ca n't see any infarction or invasion of blood vessles (only fibrin, 
inflammation and fungal filaments).  
The manuscript would clearly benefit from an image of invasion of blood vessles and/or 
infarction (maybe in a lower magnification, e.g. x10 or x20).  
 
Please, consider the following changes in the figure legends:  
Figure 3: Colon biopsies (or if you know where the biopsies come from, please indicate: 
"Biopsies from the left/right colon or from the rectum") (hematoxylin and eosin (H &amp; E) 
stain; 100x). (A) B iopsy from the center of a mucosal ulceration with sparsely septated hyphae of 
zygomycetes (arrow) lying in fibrinous exudate. (B) Biopsy from a colon polyp with surface 
deposits of fungal filaments of zygomycetes (arrow) lying in an acute suppurative infl ammation 
exudate.  
 
Figure 4: (A) Periodic acid -Schiff (PAS) stain and (B) Gomori Methenamine -Silver stain (GMS) 
highlighting the wide, ribbon -like, sparsely septated hyphae with wide -angle branching 
(approximately 90°; arrow), characteristic of zygomycetes species.  
(You coul d add an arrow where you see the 90° branching in the lower part of the image.)  
 
Please, delete Figure 6: This does not show any colonic ulcer, active colitis or neutrophilic 
infiltration (not in A and not in B).  
Spelling:  
 
- hyphae (not: hype)  
 
- zygomyce tes (not: Zygomycetes)  
 
 
 
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.  
 
Unable to assess  
 
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 interests.  
 
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