Reviewer ’s report  
 
Title: Crohn’s -like disease in a patient exposed to anti -Interleukin -17 blockade (Ixekizumab) for 
the treatment of chronic plaque psoriasis: a case re port 
 
Version: 0 Date: 20 Jul 2019  
Reviewer: Lorenzo Bertani  
Reviewer's report:  
This case report is interesting, but must be described better. In particular, on page 4, the timeline 
is not clear:  
- When steroids were started? After the index colonoscopy or after the second colonoscopy, two 
weeks later?  
- How long after the startin g of intravenous steroids infliximab was started?  
- The phrase "Histopathology from his latest colonoscopy revealed no evidence of active or 
chronic injury in all segments that were sampled" is not clear... It refers to the second 
colonoscopy (two weeks a fter the first one) or to a new colonoscopy performed after the 
induction of Infliximab?  
- How many infusions of Infliximab were performed? When psoriasis worsened? How long after 
the last Infliximab infusion Ustekinumab was started?  
Moreover, it should b e appreciable if an endoscopic follow up (specifying the timepoint) was 
described, in order to verify if Ustekinumab is effective in this particular case. However, if it is 
not available at the moment, I don't think that this information is necessary for p ublication of this 
case report, but at least a fecal calprotectin assessment must be performed in order to verify the 
disappearance of the intestinal inflammation.  
Lastly, I think that a phrase encouraging the use of fecal calprotectin as a biomarker of i ntestinal 
inflammation during anti -IL-17 treatment in psoriasis patients must be included at the end of 
discussion. Data available at present suggest the possibility of the development of IBD during 
these treatments, and this biomarker is reliably, easy to  perform and relatively cheap in diagnosis 
of IBD (Mumolo et al., "From bench to bedside: fecal calprotectin in inflammatory bowel 
diseases clinical setting", World Journal of Gastroenterology, 2018).  
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 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 explain in your comments to the authors.  
 
Unable to assess  
 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is r ecommended, 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:  
 
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, fees, funding, or salary from an 
organisation that may in any way gain or lose financia lly 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 o r 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 yo u 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 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 unde r 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: Crohn’s -like disease in a patient exposed to anti -Interleukin -17 blockade (Ixekizumab) for 
the treatment of chronic plaque psoriasis: a case re port 
 
Version: 0 Date: 20 Jul 2019  
Reviewer: Lorenzo Bertani  
Reviewer's report:  
This case report is interesting, but must be described better. In particular, on page 4, the timeline 
is not clear:  
- When steroids were started? After the index colonoscopy or after the second colonoscopy, two 
weeks later?  
- How long after the startin g of intravenous steroids infliximab was started?  
- The phrase "Histopathology from his latest colonoscopy revealed no evidence of active or 
chronic injury in all segments that were sampled" is not clear... It refers to the second 
colonoscopy (two weeks a fter the first one) or to a new colonoscopy performed after the 
induction of Infliximab?  
- How many infusions of Infliximab were performed? When psoriasis worsened? How long after 
the last Infliximab infusion Ustekinumab was started?  
Moreover, it should b e appreciable if an endoscopic follow up (specifying the timepoint) was 
described, in order to verify if Ustekinumab is effective in this particular case. However, if it is 
not available at the moment, I don't think that this information is necessary for p ublication of this 
case report, but at least a fecal calprotectin assessment must be performed in order to verify the 
disappearance of the intestinal inflammation.  
Lastly, I think that a phrase encouraging the use of fecal calprotectin as a biomarker of i ntestinal 
inflammation during anti -IL-17 treatment in psoriasis patients must be included at the end of 
discussion. Data available at present suggest the possibility of the development of IBD during 
these treatments, and this biomarker is reliably, easy to  perform and relatively cheap in diagnosis 
of IBD (Mumolo et al., "From bench to bedside: fecal calprotectin in inflammatory bowel 
diseases clinical setting", World Journal of Gastroenterology, 2018).  
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 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 explain in your comments to the authors.  
 
Unable to assess  
 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is r ecommended, 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:  
 
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, fees, funding, or salary from an 
organisation that may in any way gain or lose financia lly 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 o r 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 yo u 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 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 unde r 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: Crohn’s -like disease in a patient exposed to anti -Interleukin -17 blockade (Ixekizumab) for 
the treatment of chronic plaque psoriasis: a case re port 
 
Version: 0 Date: 20 Jul 2019  
Reviewer: Lorenzo Bertani  
Reviewer's report:  
This case report is interesting, but must be described better. In particular, on page 4, the timeline 
is not clear:  
- When steroids were started? After the index colonoscopy or after the second colonoscopy, two 
weeks later?  
- How long after the startin g of intravenous steroids infliximab was started?  
- The phrase "Histopathology from his latest colonoscopy revealed no evidence of active or 
chronic injury in all segments that were sampled" is not clear... It refers to the second 
colonoscopy (two weeks a fter the first one) or to a new colonoscopy performed after the 
induction of Infliximab?  
- How many infusions of Infliximab were performed? When psoriasis worsened? How long after 
the last Infliximab infusion Ustekinumab was started?  
Moreover, it should b e appreciable if an endoscopic follow up (specifying the timepoint) was 
described, in order to verify if Ustekinumab is effective in this particular case. However, if it is 
not available at the moment, I don't think that this information is necessary for p ublication of this 
case report, but at least a fecal calprotectin assessment must be performed in order to verify the 
disappearance of the intestinal inflammation.  
Lastly, I think that a phrase encouraging the use of fecal calprotectin as a biomarker of i ntestinal 
inflammation during anti -IL-17 treatment in psoriasis patients must be included at the end of 
discussion. Data available at present suggest the possibility of the development of IBD during 
these treatments, and this biomarker is reliably, easy to  perform and relatively cheap in diagnosis 
of IBD (Mumolo et al., "From bench to bedside: fecal calprotectin in inflammatory bowel 
diseases clinical setting", World Journal of Gastroenterology, 2018).  
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 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 explain in your comments to the authors.  
 
Unable to assess  
 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is r ecommended, 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:  
 
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, fees, funding, or salary from an 
organisation that may in any way gain or lose financia lly 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 o r 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 yo u 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 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 unde r 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