Reviewer ’s report  
Title : A case of IgG4 -related hepatic inflammatory pseudotumor replaced by an abscess af ter 
steroid treatment  
 
Version:  1 Date : 23 May 2016  
 
Reviewer : Jaime  Chu 
 
Reviewer's report:  
Shibata et al. describe "A case of IgG4 -related hepatic inflammatory pseudotumor replaced by an 
abscess after steroid treatment." The contribution of this case report is to present a hepatic 
abscess as an underdescribed complication of steroid treatment for IgG4 -related disease. In this 
revised manuscript, the authors better describe the details of their therapeutic approach. 
However, the timeline is still unclear to me - was the US done "in two months" after completely 
weaning the prednisone to off or tw o months since initial presentation?   Page 5, line 55 - "fever 
and abdominal pain recurred afterward" -- how long after the ultrasound or after prednisone was 
completely stopped?  These are important details to describe if the goal of the paper is to 
describe abscess formation secondary to steroid therapy.  
The manuscript needs to better emphasize the importance of this finding within the field of 
IgG4 -RD.  As a suggestion, the discussion could be improved by focusing on the importance of 
distinguishing bet ween IgG4 -RD abscess versus secondary complication to steroids. There are 
recent reports of IgG4 -RD presenting as an abscess with resolution without steroid treatment. It 
would be important to mention that while IgG4 -RD can present with abscess, this case report 
shows that an abscess may also be a secondary complication from immunosuppression, and 
factors that the authors believe would be important in helping to distinguish between the two.  
 
Are the methods appropriate and well described?  
If not, please specify what is req uired in your comments to the authors.  
Unable to assess  
  
Does the work include the necessary 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 explai n in your comments to the authors.  
Yes 
Are you able to asse ss 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 man uscript  
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 r eceived 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 t hat 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 o f 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 r eply 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 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/lice nses/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 : A case of IgG4 -related hepatic inflammatory pseudotumor replaced by an abscess af ter 
steroid treatment  
 
Version:  1 Date : 23 May 2016  
 
Reviewer : Jaime  Chu 
 
Reviewer's report:  
Shibata et al. describe "A case of IgG4 -related hepatic inflammatory pseudotumor replaced by an 
abscess after steroid treatment." The contribution of this case report is to present a hepatic 
abscess as an underdescribed complication of steroid treatment for IgG4 -related disease. In this 
revised manuscript, the authors better describe the details of their therapeutic approach. 
However, the timeline is still unclear to me - was the US done "in two months" after completely 
weaning the prednisone to off or tw o months since initial presentation?   Page 5, line 55 - "fever 
and abdominal pain recurred afterward" -- how long after the ultrasound or after prednisone was 
completely stopped?  These are important details to describe if the goal of the paper is to 
describe abscess formation secondary to steroid therapy.  
The manuscript needs to better emphasize the importance of this finding within the field of 
IgG4 -RD.  As a suggestion, the discussion could be improved by focusing on the importance of 
distinguishing bet ween IgG4 -RD abscess versus secondary complication to steroids. There are 
recent reports of IgG4 -RD presenting as an abscess with resolution without steroid treatment. It 
would be important to mention that while IgG4 -RD can present with abscess, this case report 
shows that an abscess may also be a secondary complication from immunosuppression, and 
factors that the authors believe would be important in helping to distinguish between the two.  
 
Are the methods appropriate and well described?  
If not, please specify what is req uired in your comments to the authors.  
Unable to assess  
  
Does the work include the necessary 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 explai n in your comments to the authors.  
Yes 
Are you able to asse ss 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 man uscript  
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 r eceived 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 t hat 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 o f 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 r eply 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 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/lice nses/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 : A case of IgG4 -related hepatic inflammatory pseudotumor replaced by an abscess af ter 
steroid treatment  
 
Version:  1 Date : 23 May 2016  
 
Reviewer : Jaime  Chu 
 
Reviewer's report:  
Shibata et al. describe "A case of IgG4 -related hepatic inflammatory pseudotumor replaced by an 
abscess after steroid treatment." The contribution of this case report is to present a hepatic 
abscess as an underdescribed complication of steroid treatment for IgG4 -related disease. In this 
revised manuscript, the authors better describe the details of their therapeutic approach. 
However, the timeline is still unclear to me - was the US done "in two months" after completely 
weaning the prednisone to off or tw o months since initial presentation?   Page 5, line 55 - "fever 
and abdominal pain recurred afterward" -- how long after the ultrasound or after prednisone was 
completely stopped?  These are important details to describe if the goal of the paper is to 
describe abscess formation secondary to steroid therapy.  
The manuscript needs to better emphasize the importance of this finding within the field of 
IgG4 -RD.  As a suggestion, the discussion could be improved by focusing on the importance of 
distinguishing bet ween IgG4 -RD abscess versus secondary complication to steroids. There are 
recent reports of IgG4 -RD presenting as an abscess with resolution without steroid treatment. It 
would be important to mention that while IgG4 -RD can present with abscess, this case report 
shows that an abscess may also be a secondary complication from immunosuppression, and 
factors that the authors believe would be important in helping to distinguish between the two.  
 
Are the methods appropriate and well described?  
If not, please specify what is req uired in your comments to the authors.  
Unable to assess  
  
Does the work include the necessary 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 explai n in your comments to the authors.  
Yes 
Are you able to asse ss 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 man uscript  
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 r eceived 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 t hat 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 o f 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 r eply 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 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/lice nses/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