Review for 10.1186/s12876-017-0647-0 (2017)

Reviewer ’s report  
 
Title: Lichenoid esophagitis presenting as fatal upper gastrointestinal bleeding in a 52 year -old 
woman. Rep ort of a case diagnosed by autopsy  
 
Version: 0 Date: 28 Jan 2017  
 
Reviewer: Manuele Furnari  
 
Reviewer's report:  
 
I read with interest the case reported by dr. Mitchell. It describes a case of death in a middle -age 
woman due to esophageal b leeding potentially caused by lichenoid inflamation.  
 
 
Esophageal involvement by lichen planus is quite rare. When present, symptoms are chronic and 
recurrent. Often skin lesions are concurrent (30 -50%). Histologic reports are even more difficult 
to find in litterature.  
 
 
Typically, long term complication is esophageal stricture. Deep ulceration leading to death has 
been never reported.  
 
 
 
Coexistence of DKA further blurs the picture.  
 
All that makes the case very intriguing. Although some aspects have to be better  discussed.  
 
 
- against what expected, there was no chronicity in the esophageal involvement. GI 
symptoms (which must be better specified in the manuscript) apparently started only in 
the very last period, and  esophageal damage was abruptly severe.  
 
 
- how do the authors explain the presence of DKA? coincidence or concurrent factor? It is 
a bit strange that the patient had two acute manifestations of two chronic disorders at the 
same time without prior symptoms.  
 
 
- since histologic features of lichenoid  esophagitis is rarely described, would it be possible 
for the authors to provide further details about the pathology? (i.e. atrophy and acanthosis 
of the squamos epithelium/Civatte bodies/etc of the mucosa next to the margin of the 
ulcer or in the brownis h mucosa close to the cardias or in the oral cavity)  
 
 
- suboptimal quality of the autopsy material, absence of positive control for CD markers, 
marked post -mortem autolysis, etc make pathology findings and conclusions weak. I feel 
hesitant and a bit scared to state this was the first case of death due to massive bleeding 
ulcer caused by LE. Therefore, I invite the authors to tone down their statement  
 
 
- I believe there are a couple of senteces that might be reviewed.....i.e "It was later learned 
that several prior to her death she had.....". Please check again the entire manuscript for 
mistyping errors.  
 
 
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comme nts 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.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical r eview?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the man uscript:  
 
Acceptable  
 
Declaration of competing interests  
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