Reviewer ’s report  
 
Title: Case Report of Patient with Cronkhite -Canada Syndrome: Sustained Remission after 
Treatment with Corticosteroids and Mesalazine  
 
Version: 0 Date: 27 Nov 2018  
 
Reviewer: Maria Pina Dore  
 
Reviewer's report:  
 
In this study Sigrid Schulte et al. presented a case of sustained remission after treatment with 
corticosteroids and mesalazine in a patient with cronkhite -canada syndrome.  
Cronkhite -Canada is a rare, nonfamilial syndrome, associated with gastrointestinal polyposis, 
diarrhea, weight loss, bleeding, alopecia, cutaneous hyperpigmentation, onychodystroph y and so 
on. The polyps are hamartomas with myxoid expansion of the lamina propria and increased 
eosinophils.  
Page 4, line 7 ………………..An intestinoscopy confirmed these findings, showing an extensive 
polyposis of the stomach, the small intestine as well as the colon…………………Please defined 
what intestinoscopy is.  
Page 4, line 12…………….The gastric tissue biopsies showed cystically enlarged crypts with 
edema and inflammatory infiltrates in the stroma region, mainly consisting of plasma cells and 
lymphocytes. The analysis of duodenal and jejunal polyps resulted in similar findings with 
cystically enlarged, mucine containing glands, a stromal edema and a dense inflammatory 
infiltrate (Figure 3).  
How the authors could explain the lack of eosinophils in the polyps?  
The authors need to no confuse vitiligo with hyperpigmentation (Page 5, line 5)  
Page 7, line 10………..This resulted in our decision to initiate mesalazine therapy and we opted 
for a dose analogous to that recommended for ulcerative colitis (3000 mg/d) [26].  Actually, the 
dose recommended for ulcerative colitis is 4.8 grams (to induce remission) and 2.4 grams (to 
maintain remission) daily in three divided doses  
Similar results were recently presented in a case report of a patients with Cronkhite -Canada 
treated  with corticosteroids and mesalazine "Long -lasting remission in a case of Cronkhite -
Canada syndrome. BMJ Case Rep. 2018"; that would be added in the discussion.  
  
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.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data s hown?  
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 aspect s 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, eit her 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 you r reply is yes to any, please give details below.  
 
I declare tha t 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/licenses/by/4.0/ ). I understand that any c omments  
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: Case Report of Patient with Cronkhite -Canada Syndrome: Sustained Remission after 
Treatment with Corticosteroids and Mesalazine  
 
Version: 0 Date: 27 Nov 2018  
 
Reviewer: Maria Pina Dore  
 
Reviewer's report:  
 
In this study Sigrid Schulte et al. presented a case of sustained remission after treatment with 
corticosteroids and mesalazine in a patient with cronkhite -canada syndrome.  
Cronkhite -Canada is a rare, nonfamilial syndrome, associated with gastrointestinal polyposis, 
diarrhea, weight loss, bleeding, alopecia, cutaneous hyperpigmentation, onychodystroph y and so 
on. The polyps are hamartomas with myxoid expansion of the lamina propria and increased 
eosinophils.  
Page 4, line 7 ………………..An intestinoscopy confirmed these findings, showing an extensive 
polyposis of the stomach, the small intestine as well as the colon…………………Please defined 
what intestinoscopy is.  
Page 4, line 12…………….The gastric tissue biopsies showed cystically enlarged crypts with 
edema and inflammatory infiltrates in the stroma region, mainly consisting of plasma cells and 
lymphocytes. The analysis of duodenal and jejunal polyps resulted in similar findings with 
cystically enlarged, mucine containing glands, a stromal edema and a dense inflammatory 
infiltrate (Figure 3).  
How the authors could explain the lack of eosinophils in the polyps?  
The authors need to no confuse vitiligo with hyperpigmentation (Page 5, line 5)  
Page 7, line 10………..This resulted in our decision to initiate mesalazine therapy and we opted 
for a dose analogous to that recommended for ulcerative colitis (3000 mg/d) [26].  Actually, the 
dose recommended for ulcerative colitis is 4.8 grams (to induce remission) and 2.4 grams (to 
maintain remission) daily in three divided doses  
Similar results were recently presented in a case report of a patients with Cronkhite -Canada 
treated  with corticosteroids and mesalazine "Long -lasting remission in a case of Cronkhite -
Canada syndrome. BMJ Case Rep. 2018"; that would be added in the discussion.  
  
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.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data s hown?  
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 aspect s 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, eit her 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 you r reply is yes to any, please give details below.  
 
I declare tha t 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/licenses/by/4.0/ ). I understand that any c omments  
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: Case Report of Patient with Cronkhite -Canada Syndrome: Sustained Remission after 
Treatment with Corticosteroids and Mesalazine  
 
Version: 0 Date: 27 Nov 2018  
 
Reviewer: Maria Pina Dore  
 
Reviewer's report:  
 
In this study Sigrid Schulte et al. presented a case of sustained remission after treatment with 
corticosteroids and mesalazine in a patient with cronkhite -canada syndrome.  
Cronkhite -Canada is a rare, nonfamilial syndrome, associated with gastrointestinal polyposis, 
diarrhea, weight loss, bleeding, alopecia, cutaneous hyperpigmentation, onychodystroph y and so 
on. The polyps are hamartomas with myxoid expansion of the lamina propria and increased 
eosinophils.  
Page 4, line 7 ………………..An intestinoscopy confirmed these findings, showing an extensive 
polyposis of the stomach, the small intestine as well as the colon…………………Please defined 
what intestinoscopy is.  
Page 4, line 12…………….The gastric tissue biopsies showed cystically enlarged crypts with 
edema and inflammatory infiltrates in the stroma region, mainly consisting of plasma cells and 
lymphocytes. The analysis of duodenal and jejunal polyps resulted in similar findings with 
cystically enlarged, mucine containing glands, a stromal edema and a dense inflammatory 
infiltrate (Figure 3).  
How the authors could explain the lack of eosinophils in the polyps?  
The authors need to no confuse vitiligo with hyperpigmentation (Page 5, line 5)  
Page 7, line 10………..This resulted in our decision to initiate mesalazine therapy and we opted 
for a dose analogous to that recommended for ulcerative colitis (3000 mg/d) [26].  Actually, the 
dose recommended for ulcerative colitis is 4.8 grams (to induce remission) and 2.4 grams (to 
maintain remission) daily in three divided doses  
Similar results were recently presented in a case report of a patients with Cronkhite -Canada 
treated  with corticosteroids and mesalazine "Long -lasting remission in a case of Cronkhite -
Canada syndrome. BMJ Case Rep. 2018"; that would be added in the discussion.  
  
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.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data s hown?  
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 aspect s 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, eit her 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 you r reply is yes to any, please give details below.  
 
I declare tha t 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/licenses/by/4.0/ ). I understand that any c omments  
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