Reviewer's report
Title:Pediatric Primary Biliary Cirrhosis and Type 2 Autoimmune Hepatitis
Overlapping Features In A 3-Year-Old Girl: A Case Study And Review of the
Literature on AMA Positivity in Pediatric Age
Version: 2Date:8 June 2012
Reviewer: fernando alvarez
Reviewer's report:
Dr Invernizzi et al. described a case of a 3 years old girl with autoimmune
hepatitis type 2, and circulating anti-mitochondrial autoantibodies.
The patient presented as an acute severe hepatitis (hepatic failure),
hyperammoniemia and neurological deterioration. It is not clear why ultrasound
examination showed signs of “chronic” parenchymal damage only in the liver
left-lobe.
An increase of serum IgG levels, but normal IgM levels were recorded at onset of
the liver disease. High serum IgG levels with normal IgM levels is a particular
sign of AIH. Increase of serum IgM, absent in this patient (see table 1), is
generally observed in patients with PBC.
Histological findings described were compatible with an AIH under treatment,
however, no signs to believe that this girl had a PBC were found (“only hepatic
lesion diagnostic of PBC is the granulomatous destruction of septal of interlobular
bile ducts”, Oxford Textbook of Clinical Hepatology). Figure 3 does not allow to
propose a possible PBC.
Initial response to treatment and further evolution were typical of an AIH, without
any sign in favour of PBC in the long term follow-up. As the authors mentioned in
the description of the case: “the cholangiopatic component “of PBC” does not
respond to immunosuppressive treatment.
This case report does not justify the title of the article : “Primary Biliary cirrhosis...
overlaping...” The title may be change to : “AIH type 2 associated with an
unexpected and transient presence of AMA”.
Level of interest: An article of insufficient interest to warrant publication in a
scientific/medical journal
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have not competing interests'.
Reviewer's report
Title:Pediatric Primary Biliary Cirrhosis and Type 2 Autoimmune Hepatitis
Overlapping Features In A 3-Year-Old Girl: A Case Study And Review of the
Literature on AMA Positivity in Pediatric Age
Version: 2Date:8 June 2012
Reviewer: fernando alvarez
Reviewer's report:
Dr Invernizzi et al. described a case of a 3 years old girl with autoimmune
hepatitis type 2, and circulating anti-mitochondrial autoantibodies.
The patient presented as an acute severe hepatitis (hepatic failure),
hyperammoniemia and neurological deterioration. It is not clear why ultrasound
examination showed signs of “chronic” parenchymal damage only in the liver
left-lobe.
An increase of serum IgG levels, but normal IgM levels were recorded at onset of
the liver disease. High serum IgG levels with normal IgM levels is a particular
sign of AIH. Increase of serum IgM, absent in this patient (see table 1), is
generally observed in patients with PBC.
Histological findings described were compatible with an AIH under treatment,
however, no signs to believe that this girl had a PBC were found (“only hepatic
lesion diagnostic of PBC is the granulomatous destruction of septal of interlobular
bile ducts”, Oxford Textbook of Clinical Hepatology). Figure 3 does not allow to
propose a possible PBC.
Initial response to treatment and further evolution were typical of an AIH, without
any sign in favour of PBC in the long term follow-up. As the authors mentioned in
the description of the case: “the cholangiopatic component “of PBC” does not
respond to immunosuppressive treatment.
This case report does not justify the title of the article : “Primary Biliary cirrhosis...
overlaping...” The title may be change to : “AIH type 2 associated with an
unexpected and transient presence of AMA”.
Level of interest: An article of insufficient interest to warrant publication in a
scientific/medical journal
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have not competing interests'.
Please review this paper.
user
Reviewer's report
Title:Pediatric Primary Biliary Cirrhosis and Type 2 Autoimmune Hepatitis
Overlapping Features In A 3-Year-Old Girl: A Case Study And Review of the
Literature on AMA Positivity in Pediatric Age
Version: 2Date:8 June 2012
Reviewer: fernando alvarez
Reviewer's report:
Dr Invernizzi et al. described a case of a 3 years old girl with autoimmune
hepatitis type 2, and circulating anti-mitochondrial autoantibodies.
The patient presented as an acute severe hepatitis (hepatic failure),
hyperammoniemia and neurological deterioration. It is not clear why ultrasound
examination showed signs of “chronic” parenchymal damage only in the liver
left-lobe.
An increase of serum IgG levels, but normal IgM levels were recorded at onset of
the liver disease. High serum IgG levels with normal IgM levels is a particular
sign of AIH. Increase of serum IgM, absent in this patient (see table 1), is
generally observed in patients with PBC.
Histological findings described were compatible with an AIH under treatment,
however, no signs to believe that this girl had a PBC were found (“only hepatic
lesion diagnostic of PBC is the granulomatous destruction of septal of interlobular
bile ducts”, Oxford Textbook of Clinical Hepatology). Figure 3 does not allow to
propose a possible PBC.
Initial response to treatment and further evolution were typical of an AIH, without
any sign in favour of PBC in the long term follow-up. As the authors mentioned in
the description of the case: “the cholangiopatic component “of PBC” does not
respond to immunosuppressive treatment.
This case report does not justify the title of the article : “Primary Biliary cirrhosis...
overlaping...” The title may be change to : “AIH type 2 associated with an
unexpected and transient presence of AMA”.
Level of interest: An article of insufficient interest to warrant publication in a
scientific/medical journal
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have not competing interests'.
assistant