Case reports in clinical medicine: why it matters and how to do it

ABSTRACT

A medical case report is a form of scholarly writing describing unique clinical vignettes that offer important learning points in patient management and generate hypotheses to spur further research. Despite its long‐standing tradition dating back to 400–1600 BC, the case report has fallen out of favour in modern medical journals due to perceived lower status in the evidence hierarchy and concerns of limited citation potential affecting journal impact factors. In this commentary, we argue for the enduring relevance of case reports in contemporary medical practice, specifically in four main areas: (1) serving as catalysts for scientific discovery, (2) contributions to clinical diagnosis/management, (3) educational value in cultivating clinical reasoning skills and (4) accessibility as a scholarly design for junior medical trainees. We then describe practical strategies for medical trainees and practitioners pertaining to case selection, consent‐taking processes, co‐author inclusion and writing styles to improve the chances of successful case report publication.

Introduction

A medical case report is a form of scholarly writing describing a real‐world, often uncommon, clinical vignette to offer unique insights that may inform patient management or generate hypotheses for further research. As a research design, the case report has an illustrious history, with earliest examples documented in ancient Greek/Egyptian texts dating back to 400–1600 BC. ¹ Despite this long‐standing tradition, case reports have fallen out of favour in modern medical journals. Publication rates have plummeted for several reasons, including their perceived lower standing within the evidence hierarchy and concerns of limited citation potential with adverse effects on journal impact factors. ² , ³

In this commentary, we argue for the enduring relevance of case reports in modern medicine and provide practical strategies for embarking on this scholarly endeavour.

Importance of case reports in modern medicine

Catalysts for scientific discovery

From a scientific inquiry perspective, case reports frequently serve as the first signal of previously unrecognised clinical phenomena. By highlighting novel associations or proposing plausible disease mechanisms, they can generate clinically meaningful questions that precede cohort studies or clinical trials. ⁴ For example, lymphoedema is a debilitating complication among patients undergoing mastectomy with axillary lymph node dissection, in whom the safety of upper limb exercises was uncertain. An initial case series on upper limb exercises after mastectomy prompted subsequent cohort studies and randomised controlled trials, which confirmed that upper limb progressive resistance exercise does not contribute to increased risk of lymphoedema. ⁵

Similarly, transformative ideas may gain traction through case‐based observations. Professor Barry Marshall's self‐experimentation (n = 1) ultimately contributed to the recognition of Helicobacter pylori as the principal cause of peptic ulcer disease, for which he was awarded the Nobel Prize in Physiology or Medicine. His earlier cohort findings suggesting a pathogenic role for the bacterium were met with scepticism. ⁶ To establish causality consistent with Koch's postulates, Marshall famously ingested a culture of H. pylori, subsequently developing gastritis. ⁷ This case‐based demonstration quickly gained traction and resulted in mainstream acceptance of the H. pylori hypothesis in the pathogenesis of peptic ulcer disease.

Contributions to clinical diagnosis and management

Case reports hold substantial clinical value. Physicians encountering rare diseases or atypical presentations often rely on published case descriptions to guide diagnostic reasoning and therapeutic decisions. ⁴

In medical toxicology, case reports are particularly important in identifying drug‐associated adverse events and guiding management, as many toxic exposures cannot be ethically studied in randomised trials. ⁸ With the rapid expansion of novel therapeutics, such as immune checkpoint inhibitors, previously unrecognised immune‐mediated toxicities are increasingly described. For instance, pembrolizumab has revolutionised cancer therapy but is associated with immune‐related adverse events affecting multiple organ systems. Rare conditions such as the ‘triple M’ syndrome (myasthenia gravis, myositis and myocarditis) have been characterised through isolated case reports and subsequent systematic syntheses. ⁹ In such rare conditions, cumulative case‐based evidence frequently provides the only available guidance for management.

Importantly, newly described disease entities often start off as isolated case descriptions. A prime example would be the recent COVID‐19 pandemic, which started off as independently reported case series ¹⁰ of a newly described infective phenomenon that quickly became a worldwide pandemic. In the realm of autoinflammatory diseases, VEXAS syndrome was first described in a 2020 case series by Beck and colleagues, which has since been widely reported worldwide based on their proposed classification criteria. ¹¹

Educational value in cultivating clinical reasoning skills

Case reports are powerful educational tools. They uniquely model the clinical reasoning process, illustrating how diagnostic and therapeutic decisions are shaped by patient context, pre‐ and post‐test probabilities, patient preferences, resource constraints and environmental factors. ² Reports published under formats such as ‘clinical reasoning’ or ‘clinical vignettes’ often explicitly demonstrate this cognitive process.

Equally important, case reports can illuminate cognitive biases, diagnostic pitfalls and system‐level errors encountered in real‐world practice, allowing clinicians to adopt preventive strategies. ¹² Moreover, exposure to rare or atypical presentations enhances pattern recognition and hypothesis generation, which are skills essential for accurate intuitive judgements. ³ Physicians cannot recognise what they have never encountered; case reports broaden that experiential repertoire. Nonetheless, it is important that physicians interpret findings reported by case reports/series appropriately, given that it is certainly underpowered to make any definitive claim of statistical significance.

Accessible scholarly engagement for trainees

Finally, case report writing offers a low barrier to scholarly participation for junior trainees. Beyond presenting at conference and achieving publication, the process of distilling a case to its essential learning points strengthens clinical reasoning and clarity of thought. Given that trainees routinely prepare cases for grand rounds, teaching conferences, peer review sessions and morbidity‐and‐mortality meetings, transforming suitable presentations into publishable manuscripts is both practical and educationally rewarding.

Practical tips for successful writing and publication of case reports

First, case selection is arguably the most important step. When identifying potential cases for publication, consider the following: (1) Is there an important teaching point to be made (e.g. specific nuances/complexities to the case such as diagnostic pitfalls, management trade‐offs, systemic issues affecting patient care such as cost concerns, resource limitations, implicit biases and other social determinants of health)? (2) Is the diagnosis or clinical presentation uncommon? (3) Is the diagnostic/management approach novel/unique (e.g. new investigative modality or procedural technique)? (4) Is there a novel postulated clinical association or mechanism of disease highlighted? ² In particular, inclusion of an instructive figure (such as clinical photos of dermatological or musculoskeletal manifestations or characteristic radiological findings) also enhances the appeal of the manuscript to readers.

Second, a thoughtful journal selection strategy should be undertaken so that the subsequent process of manuscript writing is oriented to the target journal in mind. Authors should consider (1) the primary disorder described, (2) the unique finding highlighted by the case and (3) the audience that would derive the greatest benefit from the key learning points. Additionally, a practical consideration would also be the journal's impact factor relative to the novelty of the case; for example, a completely novel case with little or no comparable literature may be more suitable for submission to higher‐impact journals. On the other hand, a local journal may be preferred for cases which are not particularly rare but offers practice context‐specific learning points. Once a target journal has been identified, the discussion may need to be reframed to align with the journal's editorial scope and clinical emphasis. In contrast to general case report platforms, subspecialty journals often favour submissions that extend mechanistic understanding – such as insights into molecular pathways, immune dynamics, pharmacologic interactions or disease evolution – rather than simply documenting clinical rarity. Accordingly, tailoring the focus of the discussion to the journal's priorities increases the likelihood of publication.

To this end, many of the larger/renowned journals no longer accept case reports but have instead created open access companion (‘sister’) journals specifically for submission of case reports/series which levy fairly hefty article processing charges (APCs). While we understand the practicality of such measures from the editorial perspective, this may create an unequal playing field for medical students, junior trainees or medical practitioners from lower‐income areas who may not be able to afford the APCs. As a middle ground, it would be helpful if the journals offerred discounts/waivers for these individuals based on their circumstances and the merit of their submitted work.

Third, timely written consent must be obtained from the patient or the next of kin (if the patient is unable to give consent or deceased). While institutional consent forms are permitted in many journals, journal‐specific forms may sometimes be required for select journals. Additionally, photo documentation of pertinent clinical findings (e.g. rashes, swollen joints and masses) is important, especially in cases where findings may disappear or evolve with treatment.

Fourth, consider including co‐authors with relevant expertise to ensure the veracity and robustness of discussion points. ² For complex cases, the clinical reasoning processes and opinions of the various clinicians across specialties should be incorporated. Inexperienced junior trainees could consult and involve the primary senior clinician, who would be able to advise on the suitability of the selected case, supervise the writing process and review/edit the manuscript. In recent years, medical educational programmes on case report writing have been developed to help trainees hone this skill. ¹³

Finally, formatting and writing style are crucial to successful publication. In general, most case reports follow a standard structure comprising three main sections: (1) introduction (providing brief, pertinent background that highlights the value of the case to be described); (2) case vignette/description (including salient aspects of clinical history, patient risk factors, examination findings, diagnostic workup, treatment and clinical response); and (3) discussion (highlighting two or three key learning points with reference to pertinent literature, but avoiding a de‐contextualised rehash of existing knowledge). The title of the case report should be concise, professional and sufficiently engaging to capture the unique aspect of the case. ⁴ To avoid redundancy and verbosity, titles such as ‘a case report and literature review’ or ‘a rare/unique case of’ should be avoided. ⁴ Authors should also adhere to journal‐specific requirements regarding word count, figures and reference limits. Clinical data must be appropriately de‐identified; otherwise, Institutional Review Board exemption/approval should be obtained where required.

Conclusion

The case report is arguably the oldest form of scientific writing, yet its prominence in contemporary academic publishing has diminished. Despite this trend, case reports remain indispensable to clinical medicine, serving as catalysts for discovery, guides for the management of rare or complex conditions and powerful educational tools. With thoughtful case selection, rigorous writing and strategic journal selection, medical trainees and practitioners can continue to contribute meaningfully to medical knowledge through this enduring form of scholarly work.

DATA AVAILABILITY STATEMENT

Data sharing not applicable to this article as no datasets were generated or analysed during the current study.