How to Write a Case Report

What is a Case Report?

A case report is an academic article that presents a topic through the lens of a single patient case or clinical encounter. Case reports often focus on rare diseases, unusual clinical presentations, or uncommon complications or events. Technically, a case report is a scientific study with the smallest possible sample size, an n = 1.

Most academic medical journals publish case reports. Their length typically ranges from 1,500 to 2,000 words and, because they contain a concise literature review, they should have several references. Most large medical journals, and many niche publications, publish case reports on a regular basis.

(If you want to know more about the other types of articles you can submit to medical journals, click here.)

How to Choose a Case Report Topic

Choosing the right topic can make or break a case report. Because case reports come with the expectation of being unique and interesting, finding the right patient case and topic can present a challenge for authors.

There are several case report archetypes that journal editors expect to see when evaluating a case report submission:

A typical presentation of a very rare disease

These case reports outline the expected presentation of a disease so rare that there is unlikely to be good epidemiologic data describing the disease in large patient populations. Typically, if there are studies describing large groups of patients with this disease, it is not rare enough to warrant a case report (unless it has an additional unusual feature). For example, this case of porphyria is a rare, classic disease that mimics more common conditions. And this case report details a rare congenital abnormality of the umbilical cord. Finally, this case report describes an uncommon condition made even less common by the population in which it was seen.

A unusual presentation of a more common disease

Some case reports describe an atypical presentation of a disease that clinicians frequently encounter. It may include unusual symptoms, exam findings, imaging, or other diagnostics. These articles help raise awareness for the range of presentations a particular condition may have. For example, this unusual presentation of Cushing’s disease mimicked another unusual disorder while this case report demonstrated a rare presentation of a child’s Kawasaki disease. This case report describes a case of polymyalgia rheumatica that manifested in an unusual location.

A rare sequela of disease

Some common diseases have sequelae or complications that are very rarely seen in patients with that disorder. Case reports describing these events educate clinicians to remain vigilant for these unusual consequences. For example, this article describes a case of compartment syndrome that developed after a jellyfish sting and this case report details an unusual complication of colonic obstruction.

A rare complication of a treatment or procedure

Sometimes, things go wrong. These case reports share unfortunate and rare iatrogenic complications. Often, these articles serve as a warning and help prevent similar complications in the future. They may also detail successful treatment of these complications. For example, this article describes an unfortunate complication of improper use of a condom catheter and this case report details a rare iatrogenic complication as well as its successful treatment.

Odd cases and the “wow” factor

Some case reports are simply bizarre, impressive, amazing, and/or jaw-dropping. While they are often so rare that they actually add little to the clinical discourse, some case reports are too interesting to ignore. After all, editors are humans, too. This case report in JAAPA, for instance, outlines a one-in-many-billions occurrence that was strange enough to garner mainstream media coverage.

Other considerations

The best case reports often come from areas of medicine in which the authors are very experienced. If you choose a case that is far outside of your comfort zone, you may not fully appreciate how common or rare a particular condition is or be able to articulate the most important parts of a diagnostic or management pathway. If you are a newer clinician or want to write up a case report from outside of your specialty, consider teaming up with a coauthor well-versed in that area.

Ensure that enough clinical data exists to full describe the case in writing. If documentation is sloppy or missing, there may not be enough detail to write a quality case report. Authors should not assume undocumented findings were normal nor should they fabricate missing portions of the presentation or clinical course.

If you’re still having trouble finding or refining your article idea, check out this free guide:

Steps to Take Before You Start Writing a Case Report

Even after choosing a case and topic, authors should take additional steps prior to writing a case report. This groundwork ensures that hours spent on the writing, editing, and submission processes are not derailed by fundamental flaws.

Obtain consent from patient

The clinician-patient dynamic is both a professional arrangement and a deeply personal relationship. Patients approach healthcare workers with the ethical assumption of privacy and confidentiality, even beyond the requirements of federal law. Even with identifying information removed, patients with rare conditions or complications (and their families) can often identify themselves from a case report, even if strangers cannot. Because of this, patient consent is essential to the publication of a case report.

Many journals require either proof or acknowledgement of patient consent prior to acceptance. Best practice is to follow the guidelines of the institution at which the patient was seen. Standardized forms are an excellent way to avoid issues and awkwardness related to this process. If your institution or organization doesn’t have standardized policies or forms, BMJ provides some best practices as well as an example of a patient consent form that can be adapted for your purposes. More discussion of the legal and ethical considerations of patient consent for case reports can be found in articles like this.

Discuss with the treating clinicians

In modern healthcare, patients are often cared for by teams of interdisciplinary professionals. Patients with rare or complex conditions may enter and exit the care of multiple teams throughout their clinical course. No single clinician or team holds the rights to a patient’s story.

Before a case report is written, authors should reach out to the other professionals who participated in the patient’s care. Some authors will simply notify other clinicians that a case report is being considered, but it may be appropriate to ask permission or even invite others to join in authorship, depending on the interest and interprofessional dynamic. It is always better to address these issues before the academic work begins to avoid any future disputes or hurt feelings.

Build your team

Before writing, assemble the team of colleagues and supporters who will assist you in writing the case report. This may include more experienced clinicians who will guide you through the clinical aspects of the case, academics who will help you with a literature review, and/or co-authors and editors who will help you with the manuscript draft and submission preparation. When working with a team, it is a good idea to establish authorship (whose contributions warrant inclusion as an author) and author order (the sequence in which authors will be listed) before you begin working.

Gather all clinical information

Case reports require detailed accounts of the patient’s presentation and clinical course. This includes dozens of data points: a complete history, physical exam, laboratory tests, imaging, and major events and outcomes. In a perfect world, all of those elements would be thoroughly documented in one easily accessible place.

In reality, patient records are a mess. Before you commit to writing a case report, ensure you have access to a complete medical record that includes all the information required to write a comprehensive case report. This may involve requesting records from other clinicians or even following up with the patient themselves.

Perform a literature review

Perform a literature review on the underlying topic of your case report. If you patient presents with a rare disease, the literature review should focus on that condition. If you focus on an unusual presentation of a common disease, it should include background information on the common disease but should focus on atypical presentations, including those relevant to your patient. If you focus on a procedural complication, your research should include basic information about that procedure and its complication rates.

The literature review for a case report is an abbreviated version of a full literature review and is not expected to include every relevant article in existence. Still, it should be an rigorous review conducted with an academic search tool (eg. MEDLINE, OVID, etc.) and should focus on high-quality, primary sources. If you are inexperienced in literature reviews, consider enlisting the help of an academic librarian or a more senior author at your institution.

Once you have completed these steps, you can proceed with your manuscript’s rough draft. The rough draft should contain the following key parts:

How to Format or Structure a Case Report

Most case reports follow a similar structure, regardless of the journal in which they are published. Authors should prepare each of the follow sections and make appropriate adjustments based on the needs and requirements of individual journals.

1. Abstract

An abstract summarizes the information within the entire case report. It is often the first portion of a manuscript that editors and readers see and it creates a first impression of the work. Abstracts may be written as a single paragraph or may be broken into sub-sections, depending on each journal’s style and formatting requirements.

While many authors write an abstract before the rest of the manuscript, I often advise writers to save the abstract for last. It is much easier to summarize a completed manuscript than to attempt to encapsulate an entire article before it is written.  

2. Introduction (Optional)

Some journals include an Introduction section in case reports while other journal omit it entirely. Check the author guidelines of your target journal to see if that particular journal requires an Introduction section.

If applicable, the introduction should include a brief overview of the case and should speak to the unusual elements or rarity of the condition. It may include citations from the brief literature review. It typically includes a single sentence describing the patient and their condition, setting up the case presentation section below.

3. Case Presentation

The Case Presentation section makes up the bulk of a case report. It describes the patient presentation and clinical course in a systematic fashion, based on the patient’s medical record and typically following the same structure as common medical documentation. The case presentation section should be thorough enough that readers fully grasp the details of the presentation, work-up, and management as they occurred in real life. It should be broken up into the individual sub-sections outlined below.

            History

The History section describes the subjective elements of the patient’s history of present illness (HPI) and includes relevant past medical, surgical, and social history. This section should include all pertinent positive and negative details, keeping the differential diagnosis and final diagnosis in mind. Take extra care in laying out the chronological order of events and temporal relationships to ensure the reader can follow the patient’s story—often, timing is everything!

            Physical Exam

The Physical Exam section discusses the objective findings of the patient’s physical exam. It should begin with vital signs and should be organized by body system. Include pertinent positive and negative findings and be especially thorough in the systems most relevant to the differential and/or final diagnosis.

            Diagnostics

The Diagnostics section includes all relevant diagnostic tests performed by the medical team(s) along with their results. This includes laboratory tests, imaging, and other diagnostic modalities. For cases in which the patients received extensive workups, authors may choose to streamline this section to include the tests most relevant to the differential and/or final diagnosis.

            Treatment/Intervention

This section should describe any treatments or interventions as they occurred in real life. This can exist as a separate section or can be included in the Clinical Course/Outcome section, whichever fits best with each individual case.

            Clinical Course/Outcome

The Clinical Course or Outcome section(s) should describe the patient’s response to treatment or intervention (if applicable) and should describe all relevant clinical events and outcomes. For patients who are hospitalized, this will include a chronological account of the patient’s hospital course, including additional tests, procedures, interventions, and complications. For outpatient cases or patients who are discharged home, this section may include additional information obtained through follow-up appointments or communications.

4. Discussion

Every case report should include a Discussion section following the description of the case itself. Much of the academic and educational value of case reports comes from the Discussion section; authors should invest enough time and energy in this section to ensure it meets high academic standards. The information in the Discussion section is largely based on the author’s literature review. All statements should include references, when appropriate.

The Discussion section can be broken into the following sections to help with organization and flow:

            Epidemiology

This portion of the discussion places the case in an epidemiologic context. It often includes the incidence and prevalence of the disorder (if known) and describes the specifics of the population in which it is normally found. This section can rely on original research articles, review articles, or other case reports or case series as references. If there is no prior record of such a case in the medical literature, the article should state that here.

            Pathophysiology

This section describes the pathophysiology of the disease or condition or describes the mechanism of an iatrogenic complication, if relevant. For case reports, this section should be concise and should focus on clinically relevant elements of the pathophysiology, when possible.

            Diagnosis

This section describes the elements of a patient’s history, exam, and diagnostic work-up that are typically used to make the diagnosis, including the gold standard tests, when applicable. This section should focus on the typical work-up of a disease, not necessarily the work-up that took place in the case presentation, and may choose to discuss differences between a typical presentation/work-up and the one described in the case presentation.

            Management

This section should focus on the typical standard of care for the disease or condition in question, if one exists. It may choose to draw comparison and contrast with the case described in the case presentation.

            Prognosis, Prevention, or Other Implications

A final section of the discussion should address any additional relevant information to educate reads on the fundamental principles of the topic. This may include the typical prognosis, natural history, or clinical course of the disease, especially as it puts the clinical course of the presented patient case in better perspective. It may be appropriate to discuss prevention strategies, especially for topics that involve complications of diseases or procedures.

5. Conclusion

The best Conclusion sections offer more than just a synopsis of the article. This section should deliver any final messages, recommendations, or parting wisdom that the readers should know about the case and the topic that it represents. Consider discussing the broader implications of the case, the challenges faced by a particular patient population, or the increased awareness clinicians should have about a particular disorder.

6. References

Like any academic article, case reports should have a References section. There is no perfect number of references for a case report, but the References section should be robust enough to support a well-informed Discussion section. References should be primary sources and should come from reputable academic sources. The References section should be formatted according to each individual journal’s author guidelines.

Where to Publish Case Reports

General Medicine Journals

Most academic journals that focus on broad, general medicine topics publish case reports. These journals range in size, prominence, and acceptance rates. When selecting a general medicine journal, consider factors like time-to-editorial-decision, journal reputation, and the journal’s target audience. Some general medicine journals include NEJM, The Lancet, and JAAPA.

Specialty Medical Journals

Many specialty journals publish case reports. For example, authors of an endocrine-related case report may consider submission to BMC Endocrine Disorders. Keep in mind, these journals have a narrower scope than broad medical journals and might have a higher threshold for what they consider clinically rare, noteworthy, or interesting within their specialty.

Journals Dedicated to Case Reports

Some entire journals are dedicated specifically to publishing case reports. These journals might focus on a particular area of medicine or might accept all clinical subject matter. These journals publish large volumes of case reports and may represent a quicker path to publication for authors. Some examples of dedicated case report journals include BMJ Case Reports and The Journal of Medical Case Reports. Some journals are both medically sub-specialized and dedicated to case reports, such as the Journal of the American Academy of Dermatology (JAAD) Case Reports.

Conferences and Symposia

Medical conferences often accept case reports for presentation as abstracts, posters, or other presentation formats. Conferences often only require the initial submission of an abstract before acceptance, making these submissions a low up-front investment. Often, conference or symposia abstracts are later published in a related journal, even if author’s don’t submit a full manuscript. Some large conferences that accept case reports are the annual AAPA conference and the Society of Critical Care Medicine’s Critical Care Congress. You can read more about the benefits of submitting to conferences here.

Examples of Case Reports

These case reports are mentioned and/or linked throughout the above article:

Alpha-gal syndrome initially misdiagnosed as chronic spontaneous urticaria in a pediatric patient

Giant umbilical cord in a normal preterm infant

Porphyria

Compartment syndrome following a jellyfish sting

Cecal perforations due to descending colon obstruction (closed loop)

Penile gangrene due to improper application of a condom catheter

Delayed percutaneous coronary intervention for an extensive iatrogenic left main coronary artery dissection

An unusual cause of pericardial effusion

Should you even bother writing a case report?

Case reports are not always the best choice of academic project. In this video, I break down why you might not want to write a case report.

Are you having trouble getting started?

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