Review for 10.1186/s12876-022-02274-1 (2022)

Reviewer’s report
Title: 
Eosinophilic enteritis accompanied by cytomegalovirus disease: a case
report
Version: 
1 
Date: 
04 Dec 2021
Reviewer's report:
In this manuscript, the authors reported a case of eosinophilic gastrointestinal
disease (EGID) accompanying cytomegalovirus (CMV) infection during steroid
therapy. The patient's condition improved after the administration of ganciclovir.
To taper and discontinue prednisolone without the relapse of eosinophilic
gastrointestinal disease, they administered azathioprine. Since EGID
accompanying CMV infection is rare, this case has certainly clinical value to
report. However, there are several problems to be concerned. EGIDs are
classified into eosinophilic gastritis (involvement of the stomach), eosinophilic
gastroenteritis (involvement of the stomach and intestine), eosinophilic enteritis
(involvement of just the small intestine), and eosinophilic colitis (involvement of
the colon). They ignored these classifications in the diagnosis of this case. They
also ignored the presence or absence of CMV gastrointestinal infections in the
diagnosis of this case. Furthermore, the existence of a direct relationship between
EGID and CMV infection has not been sufficiently investigated. In this regard, it
is important to clarify the presence or absence of CMV infection before steroid
therapy.
Comments)
1) This case report does not currently have sufficiently been examined to
diagnose eosinophilic gastroenteritis. If eosinophilic gastroenteritis was the final
diagnosis, biopsy findings of the stomach, duodenum, and large intestine by
upper gastrointestinal endoscopy and colonoscopy should have been presented.
2) For the diagnosis of gastrointestinal CMV infections, the presence or absence
of CMV enteritis should be clarified according to the definition. They should
have added immunostaining for CMV to the biopsy specimens.
3) In this case, it should be necessary to indicate whether CMV reactivation
occurred before or after steroid administration. This issue is important to show
whether the CMV infection in this case was associated with eosinophil
gastrointestinal disease or steroid therapy. 
4) In the abstract, there is same sentence in the result and conclusion, which is
inappropriate.
5) There were some overlaps in the content of the case presentation. It should be
described more concisely. 
6) In discussion, there were unnecessary descriptions that have little relation to
the diagnosis and understanding of treatment of this case. On the other hand,
there should be limitations in the diagnosis and understanding of the pathology
in this case report and should be mentioned in the discussion.
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Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
No
Are the methods sufficiently described to allow the study to be repeated?
No
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No
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No
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
No