Case Reports, Letters to the Editor, Book Reviews, Review Articles and Scientific Posters

Case Reports:

A case report describes and discusses an instance of disease in a patient.

The essential characteristic of a publishable case report is educational value. It is not true that a report must tell of a unique finding. Some case reports are published because they support the findings in previously published cases or because they are useful reminders of an important point in diagnosis or treatment.

Writing case reports for journal publication is one of the best ways to get started in medical writing. They are by their nature little mysteries that hold readers’ interest and take less time to prepare than several other types of papers.

Most case reports are on one of these five topics:

• An unexpected association between diseases or symptoms. (For example, AIDS came to be recognized, in part, because Kaposi’s sarcoma and Pneumocystis carinii pneumonia were reported in homosexual men in 1981.)
  
• An unexpected event in the course of observing or treating a patient. (The transdermal absorption of nitroglycerin and its dilating effect on blood vessels came to be understood after a physician reported headache in a patient who handled TNT powder in his daily work.)
  
• Findings that shed new light on the possible pathogenesis of a disease or an adverse effect.
  
• Unique or rare features of a disease.
  
• Unique therapeutic approaches.

Table 1 shows the questions that one journal editor expects his reviewers to ask when reviewing case reports submitted for publication. It makes a good checklist for authors to use before they submit their case reports to the editor.

Table 1.

Checklist for Case Report Authors

Introduction

Is the rationale for reporting the case adequately explained?

Is the rationale for reporting the case adequately substantiated by references?


Case Description

Is the case described adequately?

Is the case described briefly?

Is the case described clearly?

Are the results of investigations described adequately?

Are the results of less common laboratory investigations accompanied by normal values?


Discussion, Comments

Is the evidence to support the authors’ diagnosis presented adequately?

Is the evidence to support the authors’ recommendations presented adequately?

Are other plausible explanations considered and refuted?

Do authors indicate directions for future investigation or management of similar cases?

—Begg C, Cho M, Eastwood S, et al. Improving the quality of reporting randomized clinical trials: the CONSORT statement. JAMA. 1996;276:637639. Used with permission of the copyright holder, JAMA.

Journals differ widely in the formats they use for case reports, so it is essential that you check a journal’s Information to Authors page and read recent case reports before you begin writing. Some publish case reports in departments labeled Brief Reports, Adverse Effects, Letters, or Case Studies. The term case study is usually reserved for more extensive case reports; case studies tell of a few cases with similarities. 

The majority of case reports follow a pattern similar to the one used for reports of clinical studies: introduction, case description, discussion (or comments) and conclusion. 

The introduction should be brief, tell why the case is important and why it is being reported (for example, because it adds to the understanding of a clinical problem). For the sake of brevity, you should cite a few recent review articles when possible rather than many individual studies. 

The purpose of the case description is to let the reader understand the case, making clear all the pertinent findings. The case description is usually told in chronological order. Categories of information often covered in this section are

• the patient’s presenting signs and symptoms, and chief complaint or complaints
  
• medical history; any relevant family history (for example, diabetes or heart disease)
  
• social history, such as tobacco and alcohol use, use of illegal substances
  
• medication being used
  
• notable results of physical examination and laboratory tests
  
• differential diagnosis or diagnoses considered
  
• final diagnosis(es)
  
• treatment and outcome of treatment
  

For legal and ethical reasons, a patient should not be referred to by his or her initials. Use “Patient A” or some other designator that does not hint at the person’s identity. Do not use case when referring to a person—a case is an instance of disease, a patient is a person.

Provide the results of only the relevant examinations and laboratory tests, usually only those with positive results. A few journals, however, want the results of all tests and procedures presented, so that the reader can follow along in detective fashion, eliminating unlikely diagnoses and “solving” the case at the end of the report with the author.

List the laboratory’s ranges of normal values for any unusual tests performed.

The purpose of the discussion is to explain anything that isn’t clear in the case description and to offer interpretations of findings. Make clear any important point that isn’t explained in the case descriptions. For example, if you reported that liver enzymes were elevated but no significant liver dysfunction was found, tell the reader in the discussion section why the enzymes were elevated.

Refer to information in the literature that bears on the case, tell what changes, if any, in patient care the case suggests, and point out what questions deserve further research. If you say that you found no other cases in the literature, the reader would like to know how you did the literature search. For example, how far back in time did your search go, and did you limit your search to reports only in Japanese or English?

Perhaps the best-known example of a physician observing and then reporting an unusual case is that of Frederick Treves, a consulting surgeon in London. He delved into the patient’s life when reporting on the medical condition of a man known today as “The Elephant Man.” Treves described a condition that any number of other physicians must have seen but did not consider worthy of medical study. Treves’ case report early in the 20th century was the first step in a series that is important in today’s understanding of neurofibromatosis and the Proteus syndrome. It also led to two books, an award winning stage play and a successful Hollywood movie (“The Elephant Man,” Paramount Studios, 1980, starring Anthony Hopkins).