Review for 10.1186/s12876-018-0858-z (2018)

Reviewer ’s report  
 
Title: Suspected Drug -induced Liver Injury Associated with Iguratimod: A Case Report and  
Review of the Literature  
 
Version: 1 Date: 27 Dec 2017  
 
Reviewer: Rolf Teschke  
 
Reviewer's report:  
This is an interestig case report on suspected DILI by Iguratimod (I). However, causality may be 
questioned.  
 
Major points:  
 
1. Abstract and possibly the title sho uld include that causality assessment was done by RUCAM.  
 
2. Causality is  at best only possible. There is a high titer of ANA, suggesting autoimmune 
hepatitis, which likely preexisted. Other autoimmune parameters are also increased. Together 
with Sjögren syndrome, patients may have a multi -autoimmune disease. The patients has SS, 
liver tests were likely available for some years before.  
 
3. What happened during 6 -12 months after stopping cortisone, did abnormal  liver tests 
reappear, suggesting AIH?  
 
4. Ple ase provide a score for AIH.  
 
5. Please replace non -English references by English references.  
 
6. Causality assessment should be done with the updated RUCAM (Danan G, Teschke R. 
RUCAM in drug and herb induced liver injury: The update. Int J  
Mol Sci 2016; 17 (1), 14. DOI: 10.3390/ijms17010014  
 
7. RUCAM based causality is "possible" by exact scoring. AIH is a possible alternative cause, 
exclusion of other hepatitis types is incomplete, and dechallenge ALT decrease is is not 
assessable due to co rtisone treatment which prevents assessing the natural ALT course after I 
cessation, providing only 0 points.  
 
8. In the manuscript, liver function tests should be replaced by abnormal liver tests. ALT, AST, 
and ALP are not parameters of liver function.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
No 
Does the work include the necessary controls?  
If not, p lease 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.  
No 
Are you able to assess any statistics i n the manuscript or would you recommend an 
additional statistical review?  
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 manuscript:  
Needs some language corrections before being published  
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