Review for 10.1186/s12876-020-01430-9 (2020)

Reviewer’ s report
Title: A case report of pancreatic panniculitis due to acute pancreatitis with intraductal papillary
mucinous neoplasm
Version: 1Date: 23 Jun 2020
Reviewer's report:
I congratulate the authors for their astute clinical acumen in diagnosing and successfully managing
this case. Based on their report, such findings are certainly unique and worthy of widerdissemination to benefit the medical community. However, before fulfilling this obligation, itwould be beneficial for authors to clarify and gather their thoughts, analyze them, and translatethem based on the critical message they seek to deliver. Currently, the manuscript appears ratherhastily assembled and I feel as though certain aspects are rushed. I believe the authors have aninteresting point but in its current form is unsuitably delivered and will require some moderatelevel of revision that I hope will elevate the quality of this work. Please find my comments below.1.Reviewing the CARE checklist provided, the title does not include the "Case report"requirement that is mandated. I would suggest a revision of the title if the editors wish to followthe checklist entirely.2.The authors have pointed out in their introduction how pancreatic panniculitis commonly afflictsthe lower limbs and state the uniqueness of their case where truncal involvement occurred. Ifpossible, this point should be reinforced and highlighted by presenting numerical evidence (e.gonly X number of prior reports have been found in the literature. Or by presenting numbers fromprior case series (if available).)3.The authors state in their introduction how the recognition of cutaneous lesions is importantbecause they can precede abdominal symptoms. This point appears to be a central message of this
article given that it is highlighted later in the discussion as well as in the conclusion. However, in
this case, abdominal symptoms appear to have occurred prior to the onset of the patient's nodules.The authors should reconsider how this is framed and carefully formulate their messageconsistently.4.Given the importance of the cutaneous lesion, I believe it would merit further description thanwhat is provided in the report. At a minimum, its size, location with respect to other surfacelandmarks, consistency, and a description of the surrounding skin should be presented.5.Are the authors certain that this was acute pancreatitis secondary to IPMN? Given the history ofalcohol consumption, I am not certain based on the information provided. It could be that thealcohol was responsible for the acute pancreatitis and the IPMN was an incidental finding.6.There is no reported Lipase level. Given that lipase is primarily considered responsible for thesemanifestations, some justification should be provided as to why the level was not obtained. If theauthors routinely do not obtain lipase levels in such cases, brief mention should be made of thisfact. Reviewing the cases provided, Lipase elevation appears consistent in all/most cases.7.Given the patients reported improvement on day 3 in response to conservative treatment, I amnot certain why he was hospitalized for a total of 12 days and what care was taken in thisintervening period. This should be elaborated.8. The long term follow up of this case would be helpful. Did the nodule recur? Were additional
nodules noted later? How long has the patient been free of complaints? How was the IPMN
managed? Did the occurrence of these painful nodules factor in treating the IPMN differently to
how the authors would approach an incidental IPMN.9.I feel as though the authors have presented a well-rounded discussion that will be useful to futurereaders. They have reviewed commonly described skin manifestations, histologic findings. Theyfollow this with a proposed mechanism for the findings and apply this to their presentation. This isfollowed by a review of the documented causes of pancreatic panniculitis. This suitably fulfills therequirements of the provided checklist.10.As previously noted, point 11d should be revised accordingly given how this was not evident inthis case.
11.With regards to table 2. I am pleased by the authors' commitment to finding prior relevant
cases, however, I am concerned about the methodology employed in assembling this table. This isclearly not exhaustive. In reference 3 provided by the authors, Zundler and colleagues noted 130cases of pancreatic panniculitis in a 20-year time frame. This table has 21. I feel this may bemisleading to our readers, who may erroneously draw conclusions regarding the incidence of thisdisease simply based on this table. The authors should provide justifications and clarify this.a.What databases were searchedb.Was a period cut off used (e.g 2000-2020)c.What other inclusion/exclusion criteria were used to distinguish cases.
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NoAre the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
NoDoes the work include the necessary 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.
NoAre 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 furtherassessment in your comments to the editors.
Not relevant to this manuscript
Quality of written English
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Needs some language corrections before being publishedDeclaration of competing interests
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