Review for 10.1186/s12876-020-01202-5 (2020)

Reviewer ’s report  
 
Title: Invasive intestinal Mucormycosis in a 40 -year old immunocompetent patient ⸻ a rarely 
reported clinical phenomenon: A case report  
 
Version: 0 Date: 22 Nov 2019  
 
Reviewer: Daniela Lenggenhager  
 
Reviewer's report:  
 
Specific review of the histopathology:  
 
I agree that the fungal filaments shown in the histology figures, are "consistent with" 
zygomycetes/mucor.  Did the authors perfom any microbiological cultures or molecular testing to 
support/confirm this diagnosis?  
 
However, I do not fully agree with the description of the histopathologic findings:  
Please, consider the following changes in the text (line 30 -38): 
Histopathology report revealed an acute suppurative inflammation of the colon mucosa with 
extensive areas of necrosis and the detection of many wide, ribbon -like, sparsely septated fungal 
hyphae with wide -angle branching (approximately 90°), characteris tic of zygomycetes species 
and thus consistent with mucormycosis [Figure 3 and 4].  
 
Regarding the part: "Focal areas of infarction due to invasion of blood vessel walls were seen, 
suggesting angioinvasive mucormycosis."  
Unfortunately, on Fig. 3 and 4, I ca n't see any infarction or invasion of blood vessles (only fibrin, 
inflammation and fungal filaments).  
The manuscript would clearly benefit from an image of invasion of blood vessles and/or 
infarction (maybe in a lower magnification, e.g. x10 or x20).  
 
Please, consider the following changes in the figure legends:  
Figure 3: Colon biopsies (or if you know where the biopsies come from, please indicate: 
"Biopsies from the left/right colon or from the rectum") (hematoxylin and eosin (H &amp; E) 
stain; 100x). (A) B iopsy from the center of a mucosal ulceration with sparsely septated hyphae of 
zygomycetes (arrow) lying in fibrinous exudate. (B) Biopsy from a colon polyp with surface 
deposits of fungal filaments of zygomycetes (arrow) lying in an acute suppurative infl ammation 
exudate.  
 
Figure 4: (A) Periodic acid -Schiff (PAS) stain and (B) Gomori Methenamine -Silver stain (GMS) 
highlighting the wide, ribbon -like, sparsely septated hyphae with wide -angle branching 
(approximately 90°; arrow), characteristic of zygomycetes species.  
(You coul d add an arrow where you see the 90° branching in the lower part of the image.)  
 
Please, delete Figure 6: This does not show any colonic ulcer, active colitis or neutrophilic 
infiltration (not in A and not in B).  
Spelling:  
 
- hyphae (not: hype)  
 
- zygomyce tes (not: Zygomycetes)  
 
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Unable to assess  
 
Does the work include the nece ssary 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.  
 
Unable to assess  
 
Are you able to assess a ny statistics in 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:  
 
Not suitable for publication unless extensively edited  
 
 
 
 
 
 
 
 
 
 
 
 
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