There could be a private internal URL to just return username and karma to populate the user info header.
I once posted a comment which was immediately invisible to everyone besides me - I'm guessing it was marked as spam for some reason, but left visible to me so I think I successfully posted it.
Aside from the header, there's only a relatively small number of variations for any given content, right? Showdead, ability to downvote, etc? So, each of these variations gets a distinct ESI URL. Like /item_$showdead_$downvote_$etc right in the internal URL, so any combination of these is a distinct URL. Only the first user to hit any particular combination would result in a request to the backend, and that could remain in cache until its content changed. No wizardry required.