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Case Report | DOI: https://doi.org/10.31579/2690-4861/953
1Department of Respiratory and Critical Care Medicine, Changzhou Third People’s Hospital, Changzhou Medical Center, Nanjing Medical University.
2Department of Infectious Diseases, Changzhou Third People’s Hospital, Changzhou Medical Center, Nanjing Medical University.
3Department of Osteopathic Medicine, Changzhou Third People’s Hospital, Changzhou Medical Center, Nanjing Medical University.
#These authors contributed equally to this work and share first authorship.
*Corresponding Author: Xuecheng Tong, Department of Infectious Diseases, The Third People’s Hospital of Changzhou, No.300, the north road of Lan ling, Changzhou, People’s republic of China.
Citation: Yali Qiu, Ying Feng, Ruanping Zhou, Qian Liu, Qing Sun, et al, (2025), Legionella Pneumophila Pneumonia with Rapid Clinical Course in two Patients with Drug-Induced Liver Injury ：Case Report, International Journal of Clinical Case Reports and Reviews, 32(1); DOI:10.31579/2690-4861/953
Copyright: © 2025, Xuecheng Tong. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 08 December 2025 | Accepted: 17 December 2025 | Published: 23 December 2025
Keywords: legionella pneumophila; liver injury; rapid diagnostics; metagenomic next-generation sequencing; case report
Drug-induced liver injury complicated by Legionella pneumophila pneumonia is rare and often associated with poor outcomes, including death. Early diagnosis and prompt treatment are crucial for these patients. Due to its low incidence, complex clinical presentation, atypical lung lesions, and challenges in pathogen culture, Legionella infection is frequently misdiagnosed or overlooked. The inability to identify the pathogen early often leads to inappropriate anti-infective therapy, resulting in a 15 % to 30 % mortality rate, primarily due to respiratory failure, shock, and multiorgan failure. The risk of infection is significantly higher in immunocompromised individuals, such as those with malignancies, chronic obstructive pulmonary disease, diabetes, liver failure, or those on glucocorticoid therapy. While hepatic and renal involvement is uncommon, we present two cases of drug-induced liver injury complicated by Legionella pneumonia.
Legionella pneumophila (L. pneumophila, Lp), responsible for 1.9 % to 9 % of community-acquired pneumonia, is prone to under diagnosis due to its low incidence, complex clinical presentation, atypical lung lesions, and difficulty in culturing pathogenic bacteria [1]. The failure to identify the pathogen early results in the administration of ineffective anti-infective treatments, leading to a high mortality rate of 15 % to 30 % due to respiratory failure, shock, and multiorgan failure [2]. Risk factors include male sex, age over 50, diabetes, and smoking [1]. The risk of L. pneumophila infection is notably increased in immunocompromised patients, such as those with malignancy, chronic obstructive pulmonary disease (COPD), diabetes mellitus, liver failure, and glucocorticoid use[3]. In this report, we review two cases of drug-induced liver injury complicated by L. pneumophila pneumonia, a rare clinical occurrence.
Case 1：A 37-year-old woman was admitted to our hospital after experiencing one week of nausea, anorexia, and fatigue. Ten days before admission, she had self-medicated with compound paracetamol (1 tablet, three times a day), amantadine hydrochloride (100 mg, three times a day), and cefaclor tablets (0.25 g, three times a day) for a respiratory infection. Three days after taking the medications, she developed malaise, nausea, fatigue, loss of appetite, and dark urine. Liver function tests revealed significant abnormalities, prompting her transfer to our hospital for treatment of drug-induced liver injury. Currently, the diagnosis of DILI still follows the strategy of exclusion. The threshold of liver biochemistry should meet any one of the following criteria for acute DILI: (1) ALT ≥ 5 × ULN; (2) ALP ≥ 2 × ULN (particularly accompanied by an increased GGT level with bone disease ruled out); (3) ALT ≥ 3 × ULN and TBil ≥ 2 × ULN[4,5]. We added relevant content in the manuscript. The patient had a history of chronic conditions, including hypertension and type 2 diabetes, for over a year. She had been using irbesartan/hydrochlorothiazide, amlodipine benzenesulfonate, dapagliflozin, and extended-release metformin to manage her conditions. She has no family history of genetic disorders and is mentally healthy.
Laboratory tests, including antibodies for hepatitis A, C, and E viruses, as well as hepatitis B serology and autoantibodies, were negative (Table 1). Chest computed tomography (CT) showed no abnormalities.
Following her hospital admission, the patient was treated with magnesium isoglycyrrhizinate, polyene phosphatidylcholine, reduced glutathione, and Kuhuang injection. Over time, her liver function improved. However, after one week of treatment, the patient developed a fever and generalized rash, which was diagnosed as a drug rash. The suspected drug was discontinued, and she was treated with intravenous methylprednisolone. The rash gradually subsided, but the patient continued to experience recurrent high fevers, peaking at 40°C. Additionally, she reported generalized aches, headache, and chest tightness. There were no respiratory symptoms such as cough or sputum production, but she displayed signs of shock, including elevated lactate levels and hypotension. Her laboratory results are shown in Table 2. A chest CT scan revealed new consolidation in the dorsal and basal segments of the right lower lobe, raising concern for pneumonia (Figure 1). The patient was diagnosed with hospital-acquired pneumonia (HAP) and started on biapenem. Metagenomic next-generation sequencing (mNGS) identified L. pneumophila in her peripheral blood with a sequence number of 207 and a relative abundance of 100 %. Biapenem was discontinued, and she was initiated on anti-infective therapy with azithromycin (400 mg daily) and doxycycline (100 mg every 12 hours). After a period of treatment, the patient's temperature normalized, symptoms improved, and the lung lesions resolved, leading to her discharge.
Case 2: A 66-year-old female patient was admitted with a 1-week history of malaise, dark-colored urine, and pruritus. She had sustained a left scapula fracture from trauma one month prior and had taken an unspecified Chinese herbal medicine (contain Gynura segetum). Following the medication, she developed weakness, loss of appetite, and dark-colored urine. Laboratory tests at another hospital revealed abnormal liver function, prompting her referral for further treatment at our institution, where she was diagnosed with drug-induced liver injury. The patient also had a history of type 2 diabetes, treated with metformin extended-release tablets. She has no family history of genetic disorders and is mentally healthy.
Her laboratory results, shown in Table 1, were negative for antibodies to hepatitis A, C, and E, and serologic tests for hepatitis B were also negative. CT of the chest showed no abnormalities. She was diagnosed with drug-induced hepatitis with intrahepatic cholestasis and was treated with ursodeoxycholic acid, compound monoammonium glycyrrhizinate, and polyene phosphatidylcholine to protect the liver. On the 11th day of admission, the patient developed a high fever without significant respiratory symptoms such as cough or sputum. Her laboratory results are shown in Table 2. Chest radiograph showed extensive, patchy hyperdense shadows in both lungs, with partial consolidation, especially in the right lung (Figure 2). The patient was diagnosed with hospital-acquired pneumonia (HAP) and was treated with biapenem, an anti-infective agent. Despite this, the patient continued to exhibit a high fever, along with cough, sputum production, chest tightness, delirium, and hallucinations. Additionally, the patient developed intractable hyponatremia and hypochloremia. On the 18th day of hospitalization, a follow-up chest CT revealed significant progression of the pulmonary lesions. Concurrently, the patient's oxygen saturation levels dropped, and type I expiratory failure occurred, requiring immediate non-invasive ventilation. A combined IgM antibody test for nine respiratory pathogens yielded a strong positive result for L. pneumophila type 1, and urine testing confirmed the presence of the Legionella antigen. These findings confirmed the diagnosis of L. pneumophila infection. The patient was subsequently treated with moxifloxacin (400 mg once daily) and doxycycline (100 mg every 12 hours) for three weeks. Following this regimen, the patient's fever subsided, symptoms improved, and the lung lesions showed signs of absorption, allowing for discharge.
| Laboratory test | Result (normal range), case 1 | Result (normal range), case 2 |
| White blood cell | 82,800/μL(35,000-95,000/μL) | 138,500 (35,000-95,000/μL) |
| neutrophil percentage | 84.70% (40-75%) | 96.30 (40-75%) |
| glycosylated haemoglobin | 7.4 (4-6.5) | / |
| Prothrombin time | 16.10 s (11-15 s) | 12.00 s (11-15 s) |
| prothrombin activity | 61.72% (75-160%) | 121.13% (75-160%) |
Activated partial thromboplastin time | 40.50 s (24-40 s) | 31.60 s (24-40 s) |
| Alaninetransaminase | 1081.3 U/L (7-40 U/L) | 29.3 U/L (7-40 U/L) |
| aspartate aminotransferase | 863 U/L (13-35 U/L) | 14 U/L (13-35 U/L) |
| alkaline phosphatase | 133 U/L (35-100 U/L) | 518 U/L (35-100 U/L) |
| gamma-glutamyltransferase | 628.4 U/L (7-45 U/L) | 630.7 U/L (7-45 U/L) |
| lactate dehydrogenase | 386 U/L (109-245 U/L) | 309 U/L (80-285 U/L) |
| total bilirubin | 164.6 μmol/L (3.4-22 μmol/L) | 66.9 umol/L (3.4-22 μmol/L) |
| direct bilirubin | 125.2μmol/L(1.7-10.3umol/L) | 61.3μmol/L (1.7-10.3 umol/L) |
| albumin | 33.8 g/L (40-55 g/L) | 26.2 g/ L (40-55 g/L) |
Table 1: Initial relevant Laboratory Values on Presentation
| Laboratory test | Result (normal range), case 1 | Result (normal range), case 2 |
| White blood cell | 138,700/μL (35,000-95,000/μL) | 148,100 (3,5000-9,5000/μL) |
| neutrophil count | 93,000 (18,000-63,000μL) | 108,000 (18,000-63,000μL) |
| C-reactive protein | 24.43 mg/L (0-5 mg/L) | 85 mg/L (0-5 mg/L) |
| calcitonin | 0.278 ng/L (0-0.05 ng/L) | 0.845 ng/L (0-0.05 ng/L) |
| potassium | 3.56 mmol/L (3.5-5.3 mmol/L) | 3.73 mmol/L (3.5-5.3 mmol/L) |
| sodium | 117.3 mmol/L (137-147 mmol/L) | 118.1 mmol/L (137-147 mmol/L) |
| chlorine | 87.0 mmol/L (99-110 mmol/L) | 86.0 mmol/L (99-110 mmol/L) |
Table 2: Relevant Laboratory Values during the course of the disease
L. pneumophila is genetically diverse, comprising 32 species and 51 serogroups[6], with Legionella pneumophila serogroup 1 (Lp1) being the most frequently implicated in global outbreaks [7]. Upon inhalation, the pathogen infects alveolar macrophages and replicates within them. The body’s Toll-like receptors on cell surfaces recognize L. pneumophila markers, triggering the activation of transcription and nuclear factors[8]. This leads to the production of inflammatory cytokines, macrophage activation, and dendritic cell maturation, which initiates a robust immune response. Consequently, individuals with weakened immune systems, including those with advanced age, smoking history, diabetes, or those receiving glucocorticoids or immunosuppressants, are particularly vulnerable[9]. In our study, both patients had diabetes mellitus and drug-induced liver injury, which compromised their immune systems and heightened their susceptibility to infection due to extensive hepatocellular necrosis, severe dysfunction of the intrahepatic monocyte-macrophage system, impaired leukocyte adhesion, and serum complement deficiencies.
L. pneumophila is a bacterium associated with human infections, causing various clinical manifestations, including the pneumonic form (Legionnaires' disease) and the non-pneumonic form (Pontiac fever) [10]. Pontiac fever is typically a mild, self-limiting illness resembling influenza, with rapid onset. In contrast, Legionnaires' disease is a severe pneumonia that can result in permanent lung damage or death. Its incubation period ranges from 2 to 14 days. The disease often begins subtly, with respiratory symptoms initially absent or mild. Instead, the onset of toxaemia-characterized by high fever and muscle aches-is more prominent [11], and these symptoms can easily be mistaken for viral infections or sepsis. Pulmonary infections are twice as likely in patients with diabetes compared to the healthy population due to a certain degree of immunosuppression and metabolic disorder[12]. Legionnaires’ disease has been shown to result in hepatic dysfunction at higher rates compared to other causes of pneumonia. However, it is necessary to further explore the pathological mechanism of how diabetes and drug-induced liver injury synergistically led to immune deficiency and Legionella pneumonia combined with liver injury.
Current diagnostic methods for L. pneumophila include urine antigen detection, nucleic acid amplification tests (NAAT), high-throughput gene sequencing, antibody detection, and bacterial culture. Among these, culture remains the gold standard for diagnosis [10]. Urinary antigen detection has a sensitivity of 74 % and a specificity of 99.1 %, providing results within 2 to 3 days. However, caveats to sole dependence on urinary antigen testing are due to its specificity to L pneumophila subtype 1, with Legionellosis caused by other subtypes and species being potentially missed[13]. The rapid development of metagenomic next-generation sequencing (mNGS) has significantly improved diagnostic accuracy, allowing earlier detection and intervention for infected patients [14]. This technique sequences all nucleic acids in a sample, and has extensive coverage, as it is capable of detecting over 10,000 pathogens. mNGS testing can be completed within 24-36 h, but mNGS costs almost ten times more than conventional microbiological testing. In our cases, mNGS detected Legionella in peripheral blood, suggesting partial release of bacterial fragments into the bloodstream. While bacterial culture remains the diagnostic gold standard, it is not routinely used as a first-line test due to the absence of clear respiratory symptoms in the early stages of infection and the demanding culture conditions. Legionella requires a specialized medium and up to 15 days for proper growth. Changes in double serum Legionella-specific antibody titers, increasing fourfold or more between the acute and recovery phases, can also aid in diagnosis, but this method is limited to serotype 1 and is not useful for early detection, as most patients do not produce antibodies until approximately three weeks into the infection. Furthermore, the test requires an interval of 3 to 10 weeks, limiting its utility in acute cases.
Delayed treatment of L. pneumophila infections with appropriate antibiotics increases mortality. The choice of antibiotic depends on its activity and its ability to reach high intracellular concentrations in macrophages. The most effective antibiotics against Legionella include quinolones, macrolides, tetracyclines, rifampicin, and telithromycin, with quinolones and telithromycin showing particularly high efficacy [15]. For patients with underlying conditions or those whose symptoms do not improve with initial therapy, combination therapy is recommended. In the cases of the two patients in our study, both had a history of chronic diseases and presented with poor general conditions. Given the rapid progression of the disease and the unknown pathogen, we initially administered biapenem, which is effective against pneumococcus, Enterobacteriaceae, and anaerobes. After identification of L. pneumophila via peripheral blood mNGS, we switched to a combination of moxifloxacin and doxycycline. These antibiotics are the first-line treatment for Legionnaires' disease due to their bactericidal action, high intracellular concentrations, and ability to penetrate lung tissue, making them particularly effective against Legionella.
L. pneumophila pneumonia is known to be the most common cause of elevated serum hepatic transaminases and has been historically considered a clinical marker distinguishing it from other types of pneumonia [16]. Both patients in our study had diabetes mellitus and drug-induced liver injury, which compromised their immune systems and increased their susceptibility to Legionella infection. This was exacerbated by severe hepatocellular necrosis, dysfunction of the intrahepatic monocyte-macrophage system, impaired leukocyte adhesion, and serum complement defects. This case report's strength is highlighting the rare co - occurrence of drug - induced liver injury and Legionella pneumophila pneumonia, with advanced diagnosis like mNGS. However, it has limitations. The sample size of two cases restricts generalizability, and the retrospective nature may bring biases. Despite this, it offers valuable insights, and further large - scale, prospective studies are needed.
In conclusion, for immunocompromised patients with significant risk factors for L. pneumophila infection, clinical suspicion should be heightened if symptoms of infectious toxicity or multisystem involvement are present. Given the complexity of lung imaging and its lack of specificity, respiratory specimens should be prioritized for mNGS as a rapid diagnostic tool in patients at high risk for Legionella infection. Antibiotic selection should be tailored based on the patient's condition and the identified pathogen.
Acknowledgement: The authors would like to thank all the persons who participated in the research.
Disclosure: The authors declare that they have no competing interests.
Grants: This work was supported by grant from: Yali, Qiu, Department of Respiratory and Critical Care Medicine, Changzhou Medical Center project of Nanjing Medical University (Grant No. CMCB202323).
Availability of data and materials: Please contact the corresponding author for data on reasonable request.
Ethics approval and consent to participate: The studies involving human participants were reviewed and approved by the Institutional Review Board at Changzhou Third People’s Hospital (No. 02A-A2024004).
Authors’ contributions: YQ, YF and RZ designed the experiments and wrote the manuscript. QS performed the experiments. XT, as a corresponding author, designed the experiments and funded. All authors read and approved the final manuscript.
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My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.
Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."
I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.
To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.
"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".
I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.
Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.
We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.
My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.
To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina
Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.
Dear Ashley Rosa, Editorial Coordinator of the journal - Psychology and Mental Health Care. " The process of obtaining publication of my article in the Psychology and Mental Health Journal was positive in all areas. The peer review process resulted in a number of valuable comments, the editorial process was collaborative and timely, and the quality of this journal has been quickly noticed, resulting in alternative journals contacting me to publish with them." Warm regards, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. I appreciate the journal (JCCI) editorial office support, the entire team leads were always ready to help, not only on technical front but also on thorough process. Also, I should thank dear reviewers’ attention to detail and creative approach to teach me and bring new insights by their comments. Surely, more discussions and introduction of other hemodynamic devices would provide better prevention and management of shock states. Your efforts and dedication in presenting educational materials in this journal are commendable. Best wishes from, Farahnaz Fallahian.
Dear Maria Emerson, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. I am delighted to have published our manuscript, "Acute Colonic Pseudo-Obstruction (ACPO): A rare but serious complication following caesarean section." I want to thank the editorial team, especially Maria Emerson, for their prompt review of the manuscript, quick responses to queries, and overall support. Yours sincerely Dr. Victor Olagundoye.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. Many thanks for publishing this manuscript after I lost confidence the editors were most helpful, more than other journals Best wishes from, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Agrippa Hilda, Editorial Coordinator, Journal of Neuroscience and Neurological Surgery. The entire process including article submission, review, revision, and publication was extremely easy. The journal editor was prompt and helpful, and the reviewers contributed to the quality of the paper. Thank you so much! Eric Nussbaum, MD
Dr Hala Al Shaikh This is to acknowledge that the peer review process for the article ’ A Novel Gnrh1 Gene Mutation in Four Omani Male Siblings, Presentation and Management ’ sent to the International Journal of Clinical Case Reports and Reviews was quick and smooth. The editorial office was prompt with easy communication.
Dear Erin Aust, Editorial Coordinator, Journal of General Medicine and Clinical Practice. We are pleased to share our experience with the “Journal of General Medicine and Clinical Practice”, following the successful publication of our article. The peer review process was thorough and constructive, helping to improve the clarity and quality of the manuscript. We are especially thankful to Ms. Erin Aust, the Editorial Coordinator, for her prompt communication and continuous support throughout the process. Her professionalism ensured a smooth and efficient publication experience. The journal upholds high editorial standards, and we highly recommend it to fellow researchers seeking a credible platform for their work. Best wishes By, Dr. Rakhi Mishra.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. The peer review process of the journal of Clinical Cardiology and Cardiovascular Interventions was excellent and fast, as was the support of the editorial office and the quality of the journal. Kind regards Walter F. Riesen Prof. Dr. Dr. h.c. Walter F. Riesen.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. Thank you for publishing our article, Exploring Clozapine's Efficacy in Managing Aggression: A Multiple Single-Case Study in Forensic Psychiatry in the international journal of clinical case reports and reviews. We found the peer review process very professional and efficient. The comments were constructive, and the whole process was efficient. On behalf of the co-authors, I would like to thank you for publishing this article. With regards, Dr. Jelle R. Lettinga.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, I would like to express my deep admiration for the exceptional professionalism demonstrated by your journal. I am thoroughly impressed by the speed of the editorial process, the substantive and insightful reviews, and the meticulous preparation of the manuscript for publication. Additionally, I greatly appreciate the courteous and immediate responses from your editorial office to all my inquiries. Best Regards, Dariusz Ziora
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation, Auctores Publishing LLC, We would like to thank the editorial team for the smooth and high-quality communication leading up to the publication of our article in the Journal of Neurodegeneration and Neurorehabilitation. The reviewers have extensive knowledge in the field, and their relevant questions helped to add value to our publication. Kind regards, Dr. Ravi Shrivastava.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, Auctores Publishing LLC, USA Office: +1-(302)-520-2644. I would like to express my sincere appreciation for the efficient and professional handling of my case report by the ‘Journal of Clinical Case Reports and Studies’. The peer review process was not only fast but also highly constructive—the reviewers’ comments were clear, relevant, and greatly helped me improve the quality and clarity of my manuscript. I also received excellent support from the editorial office throughout the process. Communication was smooth and timely, and I felt well guided at every stage, from submission to publication. The overall quality and rigor of the journal are truly commendable. I am pleased to have published my work with Journal of Clinical Case Reports and Studies, and I look forward to future opportunities for collaboration. Sincerely, Aline Tollet, UCLouvain.
Dear Ms. Mayra Duenas, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. “The International Journal of Clinical Case Reports and Reviews represented the “ideal house” to share with the research community a first experience with the use of the Simeox device for speech rehabilitation. High scientific reputation and attractive website communication were first determinants for the selection of this Journal, and the following submission process exceeded expectations: fast but highly professional peer review, great support by the editorial office, elegant graphic layout. Exactly what a dynamic research team - also composed by allied professionals - needs!" From, Chiara Beccaluva, PT - Italy.
Dear Maria Emerson, Editorial Coordinator, we have deeply appreciated the professionalism demonstrated by the International Journal of Clinical Case Reports and Reviews. The reviewers have extensive knowledge of our field and have been very efficient and fast in supporting the process. I am really looking forward to further collaboration. Thanks. Best regards, Dr. Claudio Ligresti
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation. “The peer review process was efficient and constructive, and the editorial office provided excellent communication and support throughout. The journal ensures scientific rigor and high editorial standards, while also offering a smooth and timely publication process. We sincerely appreciate the work of the editorial team in facilitating the dissemination of innovative approaches such as the Bonori Method.” Best regards, Dr. Matteo Bonori.
I recommend without hesitation submitting relevant papers on medical decision making to the International Journal of Clinical Case Reports and Reviews. I am very grateful to the editorial staff. Maria Emerson was a pleasure to communicate with. The time from submission to publication was an extremely short 3 weeks. The editorial staff submitted the paper to three reviewers. Two of the reviewers commented positively on the value of publishing the paper. The editorial staff quickly recognized the third reviewer’s comments as an unjust attempt to reject the paper. I revised the paper as recommended by the first two reviewers.
Dear Maria Emerson, Editorial Coordinator, Journal of Clinical Research and Reports. Thank you for publishing our case report: "Clinical Case of Effective Fetal Stem Cells Treatment in a Patient with Autism Spectrum Disorder" within the "Journal of Clinical Research and Reports" being submitted by the team of EmCell doctors from Kyiv, Ukraine. We much appreciate a professional and transparent peer-review process from Auctores. All research Doctors are so grateful to your Editorial Office and Auctores Publishing support! I amiably wish our article publication maintained a top quality of your International Scientific Journal. My best wishes for a prosperity of the Journal of Clinical Research and Reports. Hope our scientific relationship and cooperation will remain long lasting. Thank you very much indeed. Kind regards, Dr. Andriy Sinelnyk Cell Therapy Center EmCell
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. It was truly a rewarding experience to work with the journal “Clinical Cardiology and Cardiovascular Interventions”. The peer review process was insightful and encouraging, helping us refine our work to a higher standard. The editorial office offered exceptional support with prompt and thoughtful communication. I highly value the journal’s role in promoting scientific advancement and am honored to be part of it. Best regards, Meng-Jou Lee, MD, Department of Anesthesiology, National Taiwan University Hospital.
Dear Editorial Team, Journal-Clinical Cardiology and Cardiovascular Interventions, “Publishing my article with Clinical Cardiology and Cardiovascular Interventions has been a highly positive experience. The peer-review process was rigorous yet supportive, offering valuable feedback that strengthened my work. The editorial team demonstrated exceptional professionalism, prompt communication, and a genuine commitment to maintaining the highest scientific standards. I am very pleased with the publication quality and proud to be associated with such a reputable journal.” Warm regards, Dr. Mahmoud Kamal Moustafa Ahmed
Dear Maria Emerson, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews’, I appreciate the opportunity to publish my article with your journal. The editorial office provided clear communication during the submission and review process, and I found the overall experience professional and constructive. Best regards, Elena Salvatore.
Dear Mayra Duenas, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews Herewith I confirm an optimal peer review process and a great support of the editorial office of the present journal
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. I am really grateful for the peers review; their feedback gave me the opportunity to reflect on the message and impact of my work and to ameliorate the article. The editors did a great job in addition by encouraging me to continue with the process of publishing.
Dear Cecilia Lilly, Editorial Coordinator, Endocrinology and Disorders, Thank you so much for your quick response regarding reviewing and all process till publishing our manuscript entitled: Prevalence of Pre-Diabetes and its Associated Risk Factors Among Nile College Students, Sudan. Best regards, Dr Mamoun Magzoub.
