Reviewer’s report
Title: Syphilitic hepatitis: A case report and review of the literature
Version: 1 Date: 23 May 2019
Reviewer: Eleanor Barnes
Reviewer's report:
Hepatitis syphilis review
This in an interesting topic and relevant as syphilis continues to be a serious public health issue in some
places, and whilst genitourinary medicine doctors routinely consider syphilis in a differential diagnosis,
this will not be the case for many general practitioners and hospital doctors in other specialties,
including Hepatology. As such this case history is a useful reminder of the condition of hepatitis caused
by  syphilis.
I have the following comments:
1. There is no sexual history given and no HIV test result-these are major omissions in the clinical
history and blood tests. If this history was not taken and the HIV test not done-then this needs to be
declared as a major omission in the case report. 
2.The manuscript needs to be edited by an English speaker throughout as there are many grammatical
and phrasing errors throughout.
3. More detail should be shown regarding the HBV serology (HBeAg, DNA, sAg) etc. 
4. Was HBV looked for in the liver biopsies? Was there evidence of liver fibrosis in the liver biopsy?
5.  What are the main learning points from the case? The case could conclude with these?
5. The authours state that the Mullick et al have defined the definition of syphilitic hepatitis-do the
authour's agree with this definition? What is the definition? This should be stated. 
6. Please state in the case report, what the Jarisch-Herxheimer reaction is-and how do you monitor for
and identify this.
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.
Yes
Are the conclusions drawn adequately 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 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 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, 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 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 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 under 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: Syphilitic hepatitis: A case report and review of the literature
Version: 1 Date: 23 May 2019
Reviewer: Eleanor Barnes
Reviewer's report:
Hepatitis syphilis review
This in an interesting topic and relevant as syphilis continues to be a serious public health issue in some
places, and whilst genitourinary medicine doctors routinely consider syphilis in a differential diagnosis,
this will not be the case for many general practitioners and hospital doctors in other specialties,
including Hepatology. As such this case history is a useful reminder of the condition of hepatitis caused
by  syphilis.
I have the following comments:
1. There is no sexual history given and no HIV test result-these are major omissions in the clinical
history and blood tests. If this history was not taken and the HIV test not done-then this needs to be
declared as a major omission in the case report. 
2.The manuscript needs to be edited by an English speaker throughout as there are many grammatical
and phrasing errors throughout.
3. More detail should be shown regarding the HBV serology (HBeAg, DNA, sAg) etc. 
4. Was HBV looked for in the liver biopsies? Was there evidence of liver fibrosis in the liver biopsy?
5.  What are the main learning points from the case? The case could conclude with these?
5. The authours state that the Mullick et al have defined the definition of syphilitic hepatitis-do the
authour's agree with this definition? What is the definition? This should be stated. 
6. Please state in the case report, what the Jarisch-Herxheimer reaction is-and how do you monitor for
and identify this.
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.
Yes
Are the conclusions drawn adequately 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 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 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, 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 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 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 under 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: Syphilitic hepatitis: A case report and review of the literature
Version: 1 Date: 23 May 2019
Reviewer: Eleanor Barnes
Reviewer's report:
Hepatitis syphilis review
This in an interesting topic and relevant as syphilis continues to be a serious public health issue in some
places, and whilst genitourinary medicine doctors routinely consider syphilis in a differential diagnosis,
this will not be the case for many general practitioners and hospital doctors in other specialties,
including Hepatology. As such this case history is a useful reminder of the condition of hepatitis caused
by  syphilis.
I have the following comments:
1. There is no sexual history given and no HIV test result-these are major omissions in the clinical
history and blood tests. If this history was not taken and the HIV test not done-then this needs to be
declared as a major omission in the case report. 
2.The manuscript needs to be edited by an English speaker throughout as there are many grammatical
and phrasing errors throughout.
3. More detail should be shown regarding the HBV serology (HBeAg, DNA, sAg) etc. 
4. Was HBV looked for in the liver biopsies? Was there evidence of liver fibrosis in the liver biopsy?
5.  What are the main learning points from the case? The case could conclude with these?
5. The authours state that the Mullick et al have defined the definition of syphilitic hepatitis-do the
authour's agree with this definition? What is the definition? This should be stated. 
6. Please state in the case report, what the Jarisch-Herxheimer reaction is-and how do you monitor for
and identify this.
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.
Yes
Are the conclusions drawn adequately 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 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 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, 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 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 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 under 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