Reviewer’s report
Title: Cholestasis and disseminated histoplasmosis in a psoriatic patient on Infliximab: case report and
review of literature
Version: 1 Date: 09 Mar 2020
Reviewer: Research Square Reviewer 1
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?
No - there are minor issues
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: The report is well written and describes an interesting case of hepatic
histoplasmosis occured in a patient with long term methotrexate and infliximab. Entire description
reveals the difficulty of the diagnosis workup.
REQUESTED REVISIONS: 
The case presentation is a little bit too extended (2 pages of case description until the final diagnosis).
The authors should reduce this part. 
However, the complication relateded to the condition (pleural effusion) were little described. What was
the nature of pleural effusion (exudate vs. transudate, protein levels, citology report). 
Without an high level of suspicion, most of the time (like in this case) the diagnosis is made on liver
biopsy. Therefore, the authors should discuss the importance of liver biopsy and, what are the typical
histology features of histoplasmis. 
In the discussion part (page 9, first paragraph), rather than listing the published case reports (that is also
presented in the Table), an integrative disscussion would be preferred (conclude the common feature of
the cases).
ADDITIONAL REQUESTS/SUGGESTIONS: 
minor typos
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
Yes
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
Yes
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  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:
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 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.
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 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: Cholestasis and disseminated histoplasmosis in a psoriatic patient on Infliximab: case report and
review of literature
Version: 1 Date: 09 Mar 2020
Reviewer: Research Square Reviewer 1
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?
No - there are minor issues
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: The report is well written and describes an interesting case of hepatic
histoplasmosis occured in a patient with long term methotrexate and infliximab. Entire description
reveals the difficulty of the diagnosis workup.
REQUESTED REVISIONS: 
The case presentation is a little bit too extended (2 pages of case description until the final diagnosis).
The authors should reduce this part. 
However, the complication relateded to the condition (pleural effusion) were little described. What was
the nature of pleural effusion (exudate vs. transudate, protein levels, citology report). 
Without an high level of suspicion, most of the time (like in this case) the diagnosis is made on liver
biopsy. Therefore, the authors should discuss the importance of liver biopsy and, what are the typical
histology features of histoplasmis. 
In the discussion part (page 9, first paragraph), rather than listing the published case reports (that is also
presented in the Table), an integrative disscussion would be preferred (conclude the common feature of
the cases).
ADDITIONAL REQUESTS/SUGGESTIONS: 
minor typos
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
Yes
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
Yes
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  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:
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 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.
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 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: Cholestasis and disseminated histoplasmosis in a psoriatic patient on Infliximab: case report and
review of literature
Version: 1 Date: 09 Mar 2020
Reviewer: Research Square Reviewer 1
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?
No - there are minor issues
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: The report is well written and describes an interesting case of hepatic
histoplasmosis occured in a patient with long term methotrexate and infliximab. Entire description
reveals the difficulty of the diagnosis workup.
REQUESTED REVISIONS: 
The case presentation is a little bit too extended (2 pages of case description until the final diagnosis).
The authors should reduce this part. 
However, the complication relateded to the condition (pleural effusion) were little described. What was
the nature of pleural effusion (exudate vs. transudate, protein levels, citology report). 
Without an high level of suspicion, most of the time (like in this case) the diagnosis is made on liver
biopsy. Therefore, the authors should discuss the importance of liver biopsy and, what are the typical
histology features of histoplasmis. 
In the discussion part (page 9, first paragraph), rather than listing the published case reports (that is also
presented in the Table), an integrative disscussion would be preferred (conclude the common feature of
the cases).
ADDITIONAL REQUESTS/SUGGESTIONS: 
minor typos
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
Yes
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
Yes
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  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:
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 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.
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 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