Review for 10.1186/s12876-021-01932-0 (2021)

Reviewer’s report
Title: 
Intestinal ulcers in a patient with myelodysplastic syndrome: a case report
Version: 
0 
Date: 
18 Jul 2021
Reviewer's report:
The authors report a clinical case of an adult with MDS, trisomy 8 and ileo-cecal
ulcerations following 4 courses of azacytidine and apparently unjustified broad-
spectrum antibiotics (ceftriaxone and imipenem). Pseudomembranous colitis was
apparently present and improved on oral vancomycin. Histology of ileal biopsies
showed some vasculatis and no granuloma were apparently present.
From previous publications, it is known that MDS, trisomy 8 and Behçet disease
may coexist, and indeed that may be the case here. It is not clear from the
manuscript what was the evolution of the ulcers following successful treatment
of C diff colitis.
The authors report a number of gene mutations in this patient (BCOP, IDH1,
PHF6, RUNX1) directing to Fig 3 that does not show any mutation! What is the
meaning of these mutations in this context. If found relevant those should be
discussed!
The history of ocular lesions and recurrent oral aphtosis make the diagnosis of
BD probable, but the authors might refer to international diagnostic consensus to
sustain their opinion (J Eur Acad Dermatol Venereol 2014 Mar;28(3):338-47).
In the end it is unclear whether the intestinal lesions healing was related to
treatment of C diff or the steroid course.
There is mention about "micro-transplantation" (line 108) that is not addressed in
the case report. Can the authors please clarify?
Please insert the meaning of MPN (line 46)
In line 84 it is mentioned that C diff toxins were identified in blood serum.
According to existing guidelines, the identification of the toxin is done in stools
(Clin Infect Dis 2018 Mar 19;66(7):e1-e48).
There is need for global English editing: no verb in line 79 and subsequent;
"after remove" in line 93; "Behçet's-like disease often implicate gastrointestinal
and performed as gastrointestinal ulcers" (line 97); "Symptoms remised" (line
104).
In the conclusion, the authors correctly recognise that their assumption of
association of diagnosis is not explained and the treatment is also unknown.
Actually this is a "limitation" and not a "shortage". The association has been
reported before and indeed some relation may exist so a more positive statement
would be appropriate.
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