How to Write A Case Report: Practical tips

A case report can be the first medical publication a medical researcher would publish in a scholarly journal. This guide aims to provide practical tips on what to publish, the steps to follow, and where to publish a case report.

What can be published as a case report

It has been accepted that cases to be reportable should have an addition to the existing literature, with one of the following domains:

Recognition and description of a new disease: It is uncommon to have patients with diseases never described in the literature, however, it can be reportable if only a few cases have previously been described.

Recognition of rare manifestations of a known disease: This can be either clinically, laboratory, or even radiologically. This is currently the most common reason for writing case reports.

Detection of adverse or beneficial side effects of drugs: This is also common, especially with the emergence of new medications and modalities of treatments. It is preferable to use the WHO causality assessment criteria to prove that the manifestations are related to the drug.

Elucidation of the mechanisms of disease: As the researcher focuses on one case, he might have detailed pathophysiology, unlike research with tens and hundreds of cases.

Medical education and audit: Journals might accept cases that have an underlying educational value, such as a unique approach to a disease, a clinical dilemma to be raised, or even a clinical question to be further discussed.

How to write a case report

Here is the step-wise approach to follow when writing the case report.

First: Identify the unique aspect: Before starting, ascertain that the case you're considering is truly unique or provides a fresh perspective or educational value. Gather relevant information about the case.

Second: Literature review: Before writing, search existing literature to ensure your case hasn't been reported before and to gather background information. This step is also important to get an idea of how to write your case description based on prior published cases. Some journals require also a review of literature for previously reported cases or similar cases. Invest time in this step and develop a table to compare previous cases.

Third: Writing the manuscript: Journals mostly require that the case report writing follows the "CARE" guidelines. A detailed description of what are the details of the case report writing guideline has been previously published. Here is the structure of the case report:

• Title:
  • Descriptive and Concise: Your title should immediately give the reader an idea of the case's core focus. Avoid vague or overly broad titles. Instead, pinpoint the unique or most interesting aspect of your case.
  • Include "Case Report": This helps in searchability and immediate recognition. For instance, instead of titling your report "A Rare Presentation of Tuberculosis," you might choose "A Rare Presentation of Tuberculosis: A Case Report."
• Patient Consent: Always obtain and document informed consent from the patient (or guardian) for publication, especially if there are identifiable details or images.
• Abstract:
  • Brief Summary: This should be a succinct overview of the case, highlighting the main findings and significance. A reader should get a general idea of the case just by reading the abstract.
  • Significance: Briefly mention why this case is of interest or its importance in the field. This can be due to the rarity of the case, a novel approach to treatment, or other unique features.
• Introduction:
  • Background on the Condition or Issue: Provide a brief overview of the medical condition or issue at hand. This sets the stage and gives readers necessary context.
  • Uniqueness or Importance: Explain why you chose to report this case. Is it a rare manifestation? Does it offer insights into a particular treatment? Establish its relevance in the medical community.
• Case Presentation:
  • Patient's History: Begin with background information about the patient, like age, gender, and any relevant medical history. For instance, did they have a similar condition before? Were there any previous treatments or surgeries?
  • Symptoms: Detail the patient's complaints and symptoms on presentation. Describe the duration, severity, and any other relevant specifics.
  • Clinical Findings: Discuss the results from physical examinations, highlighting any abnormalities or findings that contributed to the diagnosis.
  • Diagnostic Tests: Present the outcomes of tests like blood work, imaging, biopsies, etc. Include values or findings that confirmed the diagnosis or ruled out other conditions.
• Discussion:
  • Compare with Similar Cases: Here, you can reference the table you created earlier, comparing your case with previously published cases. Highlight similarities and differences.
  • Significance: Delve deeper into why this case is noteworthy. For instance, if it's a rare presentation, provide data on its rarity. If it showcases a novel treatment, detail why the treatment is innovative.
  • Implications: Discuss what this case means for the broader medical community. Does it suggest a change in practice? Does it raise new questions or concerns?
  • Learning Points: What can other clinicians learn from this case? This can range from diagnostic clues, treatment insights, or even broader lessons about patient management.
• Conclusion:
  • Summarize Key Points: Reiterate the main findings and insights from the case in a few sentences. This should serve as a takeaway message for readers.
  • Potential Implications: Briefly discuss how this case might influence clinical practice. This doesn't mean proposing broad changes based on a single case, but rather suggesting areas for further research, considerations for treatment, or diagnostic insights.

Here is also a checklist to make sure you follow the guidelines.

Where to publish a case report

There are different approaches to be followed when deciding where to publish:

• Specialty journals that accept case reports: Search for specialty journals in one of the following journal databases: PubMed; Scopus; or Web of Science.
• Case report journals, where these journals only publish case report regardless of their field. However, majority of these journals publish with fees. Here is a potential list.
• Use of journal suggestion tools, including High Yield Medicine journal suggester or JANE.
• Check journals that articles in your references were published in.

Case reports are generally more difficult to publish compared to original articles. The reason is that case reports are infrequently cited, and therefore, publishing case reports is likely to decrease the journal's impact factor. This has led many editors to remove case report sections from their journals.