A Case of COVID-19 with Acute Exacerbation after Anti-Inflammatory Treatment
, Yumiko Sakurada 3, Haorile Chagan Yasutan 4,5 and Toshio Hattori 5,*
Round 1
Reviewer 1 Report
The manuscript "A Case of COVID-19 with Acute Exacerbation after Anti-Inflammatory Treatment" is a clinical case report that describes the symptoms, treatment and outcome for a COVID-19 patient. In general, the manuscript is well written and the case is presented clearly with the relevant details adequately described. I have no major concerns with the manuscript. Before accepting this article for publication, the following points need to be addressed.
1) The authors should describe the results from table 1 in more detail. One suggestion is to highlight everything in the table that is not within normal range. This should also be then described in the text so that the readers know what they are looking for in the table.
2) In the conclusions, the readers mention that "there may be other mechanisms besides cytokine storms acting on COVID-19 lung injury. " Since this is one of the main take home messages from this report, it will be useful for the readers if the authors can discuss one or more possible mechanisms that may be playing a role in the discussion section.
3). Have similar cases describing possible role for other mechanisms (than cytokine storms) been described (published) before? I suggest that the authors check the published literature carefully and make sure they are referenced in the manuscript.
Author Response
To Reviewer 1
Thank you to the reviewers for the review.
We will reply to your comments using the attached paper.
Author Response File: 
Author Response.pdf
Reviewer 2 Report
A Case of COVID-19 with Acute Exacerbation after Anti-Inflammatory Treatment
(1751260)
(Review)
Main message of the article
The case report by Ashino and colleagues describes a case of COVID-19 patient (53-year-old woman from Japan) reporting acute exacerbation after anti-inflammatory drugs treatment. Specifically, the patient was treated with antibiotics, protease inhibitors, inhalant corticosteroids, and antivirals. Tocilizumab was added on day 2. At time of exacerbation, the authors observed an increase in galectin-9.
General Judgment Comments
The case is well described and clearly presented. The title and the abstract of the paper are informative. The paper needs more keywords in order to be properly indexed. Figures’ captions need to be made self-explanatory and some figures need to be edited to be more visible.
I would recommend for Minor Revision.
Major Issues
- In the Abstract, a final sentence in which authors give meaning to the results, highlight the manuscript’s significance, and propose future lines of research would be helpful for the reader.
- Please add further keywords to precisely index the manuscript.
- All figures’ captions need to be self-explanatory and every abbreviation needs to be clarified with the extended name. Please check them throughout the paper.
- Figure 2: please modify the upper part of the figure so that the drugs’ names are visible and not underlined in red. The figure’s legends should be disposed horizontally.
- Figure 4: authors should extend the caption. Which other inflammatory biomarker are reported?
- Line 165 Discussion: “The patient was given four kinds of drugs after admission”. Please be more specific. In the first lines of the Discussion, recap briefly the patient history, the observations, and the treatment.
- At the end of the manuscript, please add limitations of the study and future directions of research.
Minor Issues
- Line 53: a citation is missing in the squared brackets.
- Line 93: as described by who?
- Please revise the caption of Table 1, as there seems to be an error at the end.
- Line 114-115: “Figure 1b 2”. Do the authors mean “Figure 1b-2”?
- Figure 4’s caption should go on the same page of the image.
Final comments
I would recommend for Minor Revision.
Author Response
To Reviewer ２
Thank you to the reviewers for the review.
We will reply to your comments using the attached paper.
Author Response File: Author Response.pdf
