Reviewer ’s report  
 
Title: Invasive intestinal Mucormycosis in a 40 -year old immunocompetent patient ⸻ a rarely 
reported clinical phenomenon: A case report  
 
Version: 1 Date: 28 Dec 2019  
 
Reviewer: Philipp Emanuel Kaiser  
 
Reviewer's report:  
 
Language: The paper reads substantially better, yet there are still to many typos, inconstistencies 
in the use of articles, tenses and interpunctuation. It needs another round of careful corrections.  
 
 
Case presention: It reads much more understanble. Mino r suggestions:  
 
- One sentence should be introduced that comments the treatment decision against repeated 
surgery once the diagnosis of intestinal mucormycosis has been made: Too risky in view of the 
failed colecystectomy on the first attempt? Was there sp ontaneous clinical improvement?  
 
- The treatment course was very short and the reason to stop Ampho B at early stage should be 
mentioned. Rapid and full recovery? Ambisome out of stock?  
 
- I would omit the sentence "This may highlight...." (p6, l9) and leav e it for the discussion 
section.  
 
 
Discussion part: Minor suggestions:  
 
- Omit sentence "The benign course....." p8 l12. The benign course under conservative treatment 
only is not generalizable.  
 
- The lack of a histopathological "smoking gun" depicting angi oinvasion is a severe problem, 
since it challanges the diagnosis itself. Readers might rightly question whether the mainly 
superficially located hyphae are simply colonizing an ulcer of another aetiology. I feel that the 
diagnosis can be sustained, also be cause mould colonization of intestinal ulcers is not really 
something well known. If there are really no better histopathological images at hand, the issue 
should be addressed an stated that invasive disease is assumed.  
 
- A pathogenetical interpreation of  the surgical and endoscopical findings should be included: 
Fungal invasion of the colonic wall ---&gt;  microperforation at the hepatic flexure --&gt; 
subsequent adhesions to liver and gallbladder --&gt; sympathetic gallbladder wall thickening / 
achalculo us cholecystitis  
- You might include one sentence stating that the benign course of the disease in this case may be 
explained be the comparatively conserved immuncompetence of the patient and the localized 
nature of the infection at diagnosis. (e.g. at the  end of the second last Paragraph).  
 
 
 
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 nece ssary 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.  
 
Yes 
 
Are you able to assess a ny 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 t he 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 organisatio n 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, fe es, 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 jou rnal. 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: Invasive intestinal Mucormycosis in a 40 -year old immunocompetent patient ⸻ a rarely 
reported clinical phenomenon: A case report  
 
Version: 1 Date: 28 Dec 2019  
 
Reviewer: Philipp Emanuel Kaiser  
 
Reviewer's report:  
 
Language: The paper reads substantially better, yet there are still to many typos, inconstistencies 
in the use of articles, tenses and interpunctuation. It needs another round of careful corrections.  
 
 
Case presention: It reads much more understanble. Mino r suggestions:  
 
- One sentence should be introduced that comments the treatment decision against repeated 
surgery once the diagnosis of intestinal mucormycosis has been made: Too risky in view of the 
failed colecystectomy on the first attempt? Was there sp ontaneous clinical improvement?  
 
- The treatment course was very short and the reason to stop Ampho B at early stage should be 
mentioned. Rapid and full recovery? Ambisome out of stock?  
 
- I would omit the sentence "This may highlight...." (p6, l9) and leav e it for the discussion 
section.  
 
 
Discussion part: Minor suggestions:  
 
- Omit sentence "The benign course....." p8 l12. The benign course under conservative treatment 
only is not generalizable.  
 
- The lack of a histopathological "smoking gun" depicting angi oinvasion is a severe problem, 
since it challanges the diagnosis itself. Readers might rightly question whether the mainly 
superficially located hyphae are simply colonizing an ulcer of another aetiology. I feel that the 
diagnosis can be sustained, also be cause mould colonization of intestinal ulcers is not really 
something well known. If there are really no better histopathological images at hand, the issue 
should be addressed an stated that invasive disease is assumed.  
 
- A pathogenetical interpreation of  the surgical and endoscopical findings should be included: 
Fungal invasion of the colonic wall ---&gt;  microperforation at the hepatic flexure --&gt; 
subsequent adhesions to liver and gallbladder --&gt; sympathetic gallbladder wall thickening / 
achalculo us cholecystitis  
- You might include one sentence stating that the benign course of the disease in this case may be 
explained be the comparatively conserved immuncompetence of the patient and the localized 
nature of the infection at diagnosis. (e.g. at the  end of the second last Paragraph).  
 
 
 
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 nece ssary 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.  
 
Yes 
 
Are you able to assess a ny 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 t he 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 organisatio n 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, fe es, 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 jou rnal. 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: Invasive intestinal Mucormycosis in a 40 -year old immunocompetent patient ⸻ a rarely 
reported clinical phenomenon: A case report  
 
Version: 1 Date: 28 Dec 2019  
 
Reviewer: Philipp Emanuel Kaiser  
 
Reviewer's report:  
 
Language: The paper reads substantially better, yet there are still to many typos, inconstistencies 
in the use of articles, tenses and interpunctuation. It needs another round of careful corrections.  
 
 
Case presention: It reads much more understanble. Mino r suggestions:  
 
- One sentence should be introduced that comments the treatment decision against repeated 
surgery once the diagnosis of intestinal mucormycosis has been made: Too risky in view of the 
failed colecystectomy on the first attempt? Was there sp ontaneous clinical improvement?  
 
- The treatment course was very short and the reason to stop Ampho B at early stage should be 
mentioned. Rapid and full recovery? Ambisome out of stock?  
 
- I would omit the sentence "This may highlight...." (p6, l9) and leav e it for the discussion 
section.  
 
 
Discussion part: Minor suggestions:  
 
- Omit sentence "The benign course....." p8 l12. The benign course under conservative treatment 
only is not generalizable.  
 
- The lack of a histopathological "smoking gun" depicting angi oinvasion is a severe problem, 
since it challanges the diagnosis itself. Readers might rightly question whether the mainly 
superficially located hyphae are simply colonizing an ulcer of another aetiology. I feel that the 
diagnosis can be sustained, also be cause mould colonization of intestinal ulcers is not really 
something well known. If there are really no better histopathological images at hand, the issue 
should be addressed an stated that invasive disease is assumed.  
 
- A pathogenetical interpreation of  the surgical and endoscopical findings should be included: 
Fungal invasion of the colonic wall ---&gt;  microperforation at the hepatic flexure --&gt; 
subsequent adhesions to liver and gallbladder --&gt; sympathetic gallbladder wall thickening / 
achalculo us cholecystitis  
- You might include one sentence stating that the benign course of the disease in this case may be 
explained be the comparatively conserved immuncompetence of the patient and the localized 
nature of the infection at diagnosis. (e.g. at the  end of the second last Paragraph).  
 
 
 
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 nece ssary 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.  
 
Yes 
 
Are you able to assess a ny 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 t he 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 organisatio n 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, fe es, 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 jou rnal. 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