Referee report. For: Case Report: Extensive digital gangrene as a primary manifestation of late-onset systemic lupus erythematosus [version 2; peer review: 1 approved]

This case report described a 56-year-old man who presented with digital gangrene as one of the initial signs of late-onset systemic lupus erythematosus (SLE), a rare occurrence. The patient exhibited symptoms such as joint pain, hair loss, photosensitivity, and mouth ulcers, alongside pulmonary fibrosis and restrictive pulmonary disease. Despite initial treatments with hydroxychloroquine, methylprednisolone, cyclophosphamide, and calcium blockers, the lesions did not improve. However, after receiving two infusions of rituximab, there was a marked improvement in vasculitis lesions and partial improvement in dyspnea. This case highlighted digital gangrene as a rare primary manifestation of late-onset SLE.