Review for 10.1186/s12876-021-01825-2 (2021)

Reviewer’s report
Title: 
Zanubrutinib-induced liver injury- A case report and literature review
Version: 
0 
Date: 
07 Apr 2021
Reviewer's report:
1. the authors present a case they suggest is 
DILI related to zanubrutinib.
However, as with any case report which purports to be the first case of clinically
significant liver injury with a new drug , circumspection is always advised. 
2. the very long latency of 30 months is very atypical of most idiopathic causes
of DILI 
, and is more suggestive of 
agents such as minocycline or nitrofurantoin
that cause an autoimmune form of DILI after 1-3 years . Indeed, the liver biopsy
with a dense mixed inflammatory infiltrate might support such an etiology. The
absence of autoantibodies does not exclude a form of seronegative DI-AIH as
even the well-described causes of DI-AIH lack ANA, SMA etc in 25-35% of
cases. As a result, the authors should consider commenting on the drug causing 
a
form of DI-AIH , including the resolution without the need for
immunosuppression 
(as as seen with other causes of DI-AIH to differentiate it
from idiopathic AIH that tends to recur).
3. the authors should perform a RUCAM assessment of the ibrutinib cases they
list in their table 
and add this score to their discussion. 
They point out the shorter
latency periods with these 4 cases as opposed to zanubrutinib , and while the
clinical course after dechallenge is similar to their case, not all cases had
complete normalization of ALT as the first patient (Nandikolla et al) died -
which makes a causality assessment even more important given the short
latency. 
4. how is the patient doing off treatment ? Was an alternative drug started? and if
so, what has been the outcome of LFTs ?Was rechallenge with zanubrutinib 
ever
considered? 
5. minor spelling - pruritus
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