Review for 10.1186/s12876-020-01559-7 (2020)

Reviewer’s report
Title: 
Immunoglobulin G4-associated autoimmune hepatitis with peripheral
blood eosinophilia: a case report.
Version: 
0 
Date: 
10 Aug 2020
Reviewer's report:
In this report the authors present a rare case with IgG4-AIH with peripheral
blood eosinophilia. This case is of interest, as it highlights specific features of
this entity and contributes to ongoing efforts to highlight characteristics of IgG4-
related hepatopathy. 
Some drawbacks are present.
1) the authors should refer to previous or ongoing use of drugs or use of
supplements/herbals that could have induced AIH and could also explain high
eosinophil count. 
2) Diagnosis: to add the simplified AIH score and add also the references the
Clinical practice guidelines from the European association for the study of the
liver.
3) To report on methods of autoantibody testing. Were ELISAs or
Immunoblotting used for autoantibody testing? 
4) The authors should explain why they have use only prednisolone monotherapy
as treatment for this patient. Existing reports report on good response to
combination treatment with prednisolone and azathioprine. 
Considering that the patients has already received 3 years of prednisolone
treatment, it would be important to perform a second liver biopsy to assess
histological remission and in addition to evaluate eosinophilis infiltrate. 
5) The authors should include a table with main laboratory values (ALT, AST, 
γ
GT, ALP, bilirubin total/conjugated, IgG, IgG4, PT (INR), total weight blood
count and eosinophil blood count) at presentation and during remission after
steroid treatment. 
6) In the discussion section, the authors should also report that the presence of
eosinophilic infiltrate (>5/HPF) is not a characteristic feature of IgG4-AIH, as
this has been reported also in patients with AIH (see Umemura T et al. J
Gastroenterol 2011, 46 Suppl 1:48-55).
In page 8, lines 5-8: "In conclusion, we report a rare case of IgG4-AIH with
peripheral blood eosinophilia and no other organ involvement". This is rather an
arbitrary statement, as no further investigations were undertaken to exclude or to
confirm this. The authors should explain, that this conclusion was based on the
absence of symptoms related to other organs. 
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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?
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from apparent manipulation?
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