Reviewer ’s report  
 
Title: Hepatic predominant presentation of Kawasaki Disease in Adolescence and review of  
literature  
 
Version: 0 Date: 23 Jun 2020  
 
Reviewer's report:  
 
PEER REVIEWER ASSESSMENTS:  
 
RELEVANCE - Does this case report make a contributio n to medical knowledge, have educational 
value, or highlight the need for a change in clinical practice or diagnostic/prognostic approaches?  
No, the findings of this report are well known and/or similar reports have already been published  
 
CASE DESCRIPTIO N - Are the details of the case sufficiently well described to understand the 
patient's symptoms and course of treatment?  
No - there are minor issues  
 
DIAGNOSIS/INTERPRETATION - Based on the facts presented, are the diagnosis, 
interpretation, and course o f 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 include d? 
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 describes  a rare case of hepatic presentation of Kawasaki 
Disease in an adolescent; but, this has previously been observed and reported in the medical 
literature several times which is acknowledged by the literature review.  
 
Other limitations in this manuscript, is  that this case report is not novel and does not contribute to 
current scientific literature.  
 
REQUESTED REVISIONS:  
1. The ultrasound descriptions should specifically comment on the gallbladder since Kawasaki 
disease has been associated with gallbladder a bnormalities 2. The discussion should speculate on 
why the hepatic involvement is more common in adolescents and adults then in children with 
Kawasaki disease - why is this so? This is important in distinguishing this case report from the 
previous reports o f this association  
ADDITIONAL REQUESTS/SUGGESTIONS:  
Inclusion of specific gallbladder findings on each ultrasound and speculation as to why adolescents 
and adults present with hepatic manifestations but younger children do not  
 
Publons Reviewer Recognition . Springer Nature can send verifica tion 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 upon publication of the manuscript.  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 re cognize your review on your new 
profile page. Publons may use t he Review Data to generate derivat ive metadata for the be nefit of 
Publons and you as a reviewer, carefully considering the sensi tivity of such information. For 
example, Publons may verify your record as a reviewer by updatin g your profile published on its 
webservice if you have registered for such service or help editors t o identify candidate reviewers. 
Please find the details of processing in Publons ’ privacy policy https://publons.com/about/terms  
 
No 
 
Are the methods appropriate and wel l described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
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 adequa tely 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 manus cript or would you recommend an additional 
statistical review?  
If an additional statistical review is recommended, please speci fy 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 : 
 
Acceptable  
 
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, f ees, funding, or salary from an 
organisation that may in  any way gain or lose financial ly 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 t he 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 intere sts' 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 t hese reviews. This reviewer has 
agreed to publication of their comments online under a Creative Commo ns Attribution License  
attributed to Research Square and was paid a small honorarium f or 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://creativec ommons.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 edi torial office 
before completing the review.  If you wish, you can include your name in your publish ed 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)  
Reviewer ’s report  
 
Title: Hepatic predominant presentation of Kawasaki Disease in Adolescence and review of  
literature  
 
Version: 0 Date: 23 Jun 2020  
 
Reviewer's report:  
 
PEER REVIEWER ASSESSMENTS:  
 
RELEVANCE - Does this case report make a contributio n to medical knowledge, have educational 
value, or highlight the need for a change in clinical practice or diagnostic/prognostic approaches?  
No, the findings of this report are well known and/or similar reports have already been published  
 
CASE DESCRIPTIO N - Are the details of the case sufficiently well described to understand the 
patient's symptoms and course of treatment?  
No - there are minor issues  
 
DIAGNOSIS/INTERPRETATION - Based on the facts presented, are the diagnosis, 
interpretation, and course o f 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 include d? 
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 describes  a rare case of hepatic presentation of Kawasaki 
Disease in an adolescent; but, this has previously been observed and reported in the medical 
literature several times which is acknowledged by the literature review.  
 
Other limitations in this manuscript, is  that this case report is not novel and does not contribute to 
current scientific literature.  
 
REQUESTED REVISIONS:  
1. The ultrasound descriptions should specifically comment on the gallbladder since Kawasaki 
disease has been associated with gallbladder a bnormalities 2. The discussion should speculate on 
why the hepatic involvement is more common in adolescents and adults then in children with 
Kawasaki disease - why is this so? This is important in distinguishing this case report from the 
previous reports o f this association  
ADDITIONAL REQUESTS/SUGGESTIONS:  
Inclusion of specific gallbladder findings on each ultrasound and speculation as to why adolescents 
and adults present with hepatic manifestations but younger children do not  
 
Publons Reviewer Recognition . Springer Nature can send verifica tion 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 upon publication of the manuscript.  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 re cognize your review on your new 
profile page. Publons may use t he Review Data to generate derivat ive metadata for the be nefit of 
Publons and you as a reviewer, carefully considering the sensi tivity of such information. For 
example, Publons may verify your record as a reviewer by updatin g your profile published on its 
webservice if you have registered for such service or help editors t o identify candidate reviewers. 
Please find the details of processing in Publons ’ privacy policy https://publons.com/about/terms  
 
No 
 
Are the methods appropriate and wel l described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
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 adequa tely 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 manus cript or would you recommend an additional 
statistical review?  
If an additional statistical review is recommended, please speci fy 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 : 
 
Acceptable  
 
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, f ees, funding, or salary from an 
organisation that may in  any way gain or lose financial ly 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 t he 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 intere sts' 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 t hese reviews. This reviewer has 
agreed to publication of their comments online under a Creative Commo ns Attribution License  
attributed to Research Square and was paid a small honorarium f or 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://creativec ommons.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 edi torial office 
before completing the review.  If you wish, you can include your name in your publish ed 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)  
Please review this paper.
user
Reviewer ’s report  
 
Title: Hepatic predominant presentation of Kawasaki Disease in Adolescence and review of  
literature  
 
Version: 0 Date: 23 Jun 2020  
 
Reviewer's report:  
 
PEER REVIEWER ASSESSMENTS:  
 
RELEVANCE - Does this case report make a contributio n to medical knowledge, have educational 
value, or highlight the need for a change in clinical practice or diagnostic/prognostic approaches?  
No, the findings of this report are well known and/or similar reports have already been published  
 
CASE DESCRIPTIO N - Are the details of the case sufficiently well described to understand the 
patient's symptoms and course of treatment?  
No - there are minor issues  
 
DIAGNOSIS/INTERPRETATION - Based on the facts presented, are the diagnosis, 
interpretation, and course o f 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 include d? 
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 describes  a rare case of hepatic presentation of Kawasaki 
Disease in an adolescent; but, this has previously been observed and reported in the medical 
literature several times which is acknowledged by the literature review.  
 
Other limitations in this manuscript, is  that this case report is not novel and does not contribute to 
current scientific literature.  
 
REQUESTED REVISIONS:  
1. The ultrasound descriptions should specifically comment on the gallbladder since Kawasaki 
disease has been associated with gallbladder a bnormalities 2. The discussion should speculate on 
why the hepatic involvement is more common in adolescents and adults then in children with 
Kawasaki disease - why is this so? This is important in distinguishing this case report from the 
previous reports o f this association  
ADDITIONAL REQUESTS/SUGGESTIONS:  
Inclusion of specific gallbladder findings on each ultrasound and speculation as to why adolescents 
and adults present with hepatic manifestations but younger children do not  
 
Publons Reviewer Recognition . Springer Nature can send verifica tion 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 upon publication of the manuscript.  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 re cognize your review on your new 
profile page. Publons may use t he Review Data to generate derivat ive metadata for the be nefit of 
Publons and you as a reviewer, carefully considering the sensi tivity of such information. For 
example, Publons may verify your record as a reviewer by updatin g your profile published on its 
webservice if you have registered for such service or help editors t o identify candidate reviewers. 
Please find the details of processing in Publons ’ privacy policy https://publons.com/about/terms  
 
No 
 
Are the methods appropriate and wel l described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
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 adequa tely 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 manus cript or would you recommend an additional 
statistical review?  
If an additional statistical review is recommended, please speci fy 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 : 
 
Acceptable  
 
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, f ees, funding, or salary from an 
organisation that may in  any way gain or lose financial ly 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 t he 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 intere sts' 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 t hese reviews. This reviewer has 
agreed to publication of their comments online under a Creative Commo ns Attribution License  
attributed to Research Square and was paid a small honorarium f or 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://creativec ommons.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 edi torial office 
before completing the review.  If you wish, you can include your name in your publish ed 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)  
assistant