Reviewer's report
Title:Anastrozole-related acute hepatitis with autoimmune features: a case
report.
Version: 1Date:23 December 2010
Reviewer: Raúl J J Andrade
Reviewer's report:
In this manuscript, Inno et al. present a case of anastrozole induced acute liver
injury with mild titer of antinuclear antibodies. The authors conclude that
anastrozole can cause liver injury through an immune mechanism. The case
report is well documented and interesting since only two cases of hepatotoxicity
attributed to the compound have been previously reported. The main problem is
that the discussion regarding the mechanisms potentially involved in
anastrozle-related hepatic injury is not focused enough.
General suggestions to consider for improving the manuscript are as follow:
1. Abstract: the first 3 lines of the conclusions are speculative and should be
removed.
2. Case description: normal values for liver enzymes should be listed. The mild
dilatation of intrahepatic bile ducts elicited by abdominal ultrasound and CT scan
would suggest an obstructive process in biliary tract. Why did the authors not
perform another imaging technique to rule out this possibility? Please, explain.
3. Discussion: this subsection needs to be more focused. Rather than general
comments on the several mechanisms and underlying pathways leading to
drug-induced liver injury, a detailed comparison with the other two reports
published is necessary. Besides, comments on the most specific finding of this
case report, the presence of antinuclear antibodies that disappeared upon
normalization of liver enzymes as compared with other typical instances of
hepatotoxicity with autoimmune features (i.e. minocycline, nitrofurantoin.,) is also
advisable. Autoimmune like DILI is a controversial and poorly understood issue.
A recent article that could help shed light on this area is available (Hepatology
2010; 51:2040-2048).
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:Anastrozole-related acute hepatitis with autoimmune features: a case
report.
Version: 1Date:23 December 2010
Reviewer: Raúl J J Andrade
Reviewer's report:
In this manuscript, Inno et al. present a case of anastrozole induced acute liver
injury with mild titer of antinuclear antibodies. The authors conclude that
anastrozole can cause liver injury through an immune mechanism. The case
report is well documented and interesting since only two cases of hepatotoxicity
attributed to the compound have been previously reported. The main problem is
that the discussion regarding the mechanisms potentially involved in
anastrozle-related hepatic injury is not focused enough.
General suggestions to consider for improving the manuscript are as follow:
1. Abstract: the first 3 lines of the conclusions are speculative and should be
removed.
2. Case description: normal values for liver enzymes should be listed. The mild
dilatation of intrahepatic bile ducts elicited by abdominal ultrasound and CT scan
would suggest an obstructive process in biliary tract. Why did the authors not
perform another imaging technique to rule out this possibility? Please, explain.
3. Discussion: this subsection needs to be more focused. Rather than general
comments on the several mechanisms and underlying pathways leading to
drug-induced liver injury, a detailed comparison with the other two reports
published is necessary. Besides, comments on the most specific finding of this
case report, the presence of antinuclear antibodies that disappeared upon
normalization of liver enzymes as compared with other typical instances of
hepatotoxicity with autoimmune features (i.e. minocycline, nitrofurantoin.,) is also
advisable. Autoimmune like DILI is a controversial and poorly understood issue.
A recent article that could help shed light on this area is available (Hepatology
2010; 51:2040-2048).
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:Anastrozole-related acute hepatitis with autoimmune features: a case
report.
Version: 1Date:23 December 2010
Reviewer: Raúl J J Andrade
Reviewer's report:
In this manuscript, Inno et al. present a case of anastrozole induced acute liver
injury with mild titer of antinuclear antibodies. The authors conclude that
anastrozole can cause liver injury through an immune mechanism. The case
report is well documented and interesting since only two cases of hepatotoxicity
attributed to the compound have been previously reported. The main problem is
that the discussion regarding the mechanisms potentially involved in
anastrozle-related hepatic injury is not focused enough.
General suggestions to consider for improving the manuscript are as follow:
1. Abstract: the first 3 lines of the conclusions are speculative and should be
removed.
2. Case description: normal values for liver enzymes should be listed. The mild
dilatation of intrahepatic bile ducts elicited by abdominal ultrasound and CT scan
would suggest an obstructive process in biliary tract. Why did the authors not
perform another imaging technique to rule out this possibility? Please, explain.
3. Discussion: this subsection needs to be more focused. Rather than general
comments on the several mechanisms and underlying pathways leading to
drug-induced liver injury, a detailed comparison with the other two reports
published is necessary. Besides, comments on the most specific finding of this
case report, the presence of antinuclear antibodies that disappeared upon
normalization of liver enzymes as compared with other typical instances of
hepatotoxicity with autoimmune features (i.e. minocycline, nitrofurantoin.,) is also
advisable. Autoimmune like DILI is a controversial and poorly understood issue.
A recent article that could help shed light on this area is available (Hepatology
2010; 51:2040-2048).
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
assistant