State your case: Guide on writing a case report

A case report or a case series is a detailed narrative documenting a medical issue encountered by one or more patients, intended for medical, scientific, or educational purposes.1 The significance of recording and disseminating distinctive clinical cases can be traced back to medical professionals in ancient Egypt.2 Today, case reports (and series) continue to play a crucial role in disseminating medical insights that may not be fully captured through conventional research methods.3 Detailing novel incidents, uncommon adverse reactions, or singular experiences can enhance future patient care by offering insights that might remain unnoticed in clinical trials.4 Additionally, case reports can serve as starting points for larger studies and provide valuable educational experiences for gastroenterology fellows, as they involve literature reviews that contribute to future clinical expertise and academic inquiry. Within gastroenterology, there is a vast diversity of pathology, technological advancements, and novel treatments lending itself to fantastic subject matter for case reports.5, 6 Here we provide guidance on how to write a case report. Begin by conducting a PubMed search to determine whether similar cases have been published. Evaluate whether your case offers a unique perspective or valuable learning point. Consider discussing your findings with a mentor or an expert for further insight. A suitable case or cases for reporting and publication should either challenge established norms, stimulate further research, or introduce a replicable novel model or endoscopic technique7 addressing common issues encountered by the gastroenterologist. For instance, Journal of Pediatric Gastroenterology and Nutrition (JPGN) and JPGN Reports will only accept case reports that describe new conditions or provide new insight into pathology, diagnosis, or treatment of a gastrointestinal condition. Additionally, JPGN and JPGN reports accept Case Images and Case Videos. Please refer to the website for further details (https://onlinelibrary.wiley.com/page/journal/2691171x/homepage/author-guidelines). Case reports typically involve three or fewer patients, whereas case series involve more than three patients.8 Most scientific journals mandate obtaining parental consent and/or a child's assent for case reports. For case series, Institutional Review Board (IRB) approval may be necessary depending on the institution's guidelines. It is important to highlight that there are alternatives to obtaining patients' consent if patients are unreachable. Discuss consent alternatives with IRB or Confidentiality/Privacy Officer. Identify a peer-reviewed journal or platform that accepts case reports/series. When identifying the journal and target readership, it's important to note that the presentation of a case report may vary based on the readership. Familiarize yourself with the journal's guidelines, submission requirements, and cost. Be familiar with the journal's rules for artificial intelligence use in writing manuscripts. Select your mentor thoughtfully. Your mentor can assist you identify co-authors. Mentors and co-authors can help you transform your case into an engaging and informative report, and guide your submission to a suitable journal.6 Involving members from other disciplines, such as Radiologists, Pathologists, and Surgeons, enhances the strength of your case report and provides valuable insights. Case reports/series are shorter than other types of medical publications. The article should include a title, abstract, introduction, detailed description of the case, discussion with thorough literature review, and conclusion.3 Visuals can enhance clarity and flow.4 Table 1 provides a template and a checklist to guide the writing of a high-quality case report. Introduction: What is new? Case presentation: Symptoms and clinical presentation Main diagnosis and intervention Main outcome Discussion Summary of literature review as it relates to the nuances of the case Justify uniqueness of the case Conclusion Main lesson for the reader Patient information Demographics Narrative of presenting illness (chief compliant and present illness) Relevant medical, surgical, social, family history, include diet, genetics, and relevant comorbidities as appropriate Clinical findings Describe relevant physical examination findings Diagnostics Include relevant laboratory, imaging, endoscopic, histologic findings as appropriate. Including staging if relevant Diagnostic challenges Interventions Type and duration of the interventions Pharmacologic; dose strength, route Procedure or surgery Changes in interventions with rationale Outcome Physician and patient related outcomes Pertinent follow-up results Unexpected or adverse events Timeline (figure or table) Establish temporal and causal relationship Goal: Illustrate major findings Size: Uniform size, fit in line with the text Focus: Ensure the final product remains in focus after editing Consider arrows or guides for your readers to quickly focus on points of interest Caption: A brief title and description of the image. Explain any arrows or abbreviations used. Relevant literature review Rationale for conclusions Establish cause and effect Strengths and limitations of the case management Main lessons for the reader Consent and assent IRB, for case series A title should be concise and captivating, explaining the relevance of the case. Avoid redundant or overly grandiose language (e.g., first ever).4 You can include the term “case report” or “case series” along with the symptom or phenomenon of greatest interest.1 The abstract will be a summary allowing readers to quickly identify the merits of the case report.9 It should succinctly summarize the clinical scenario and essential case information, and conclude with the main lessons.3 The introduction should build from your title in guiding the relevant audience along the case.4 To give all readers a common platform, start with a preliminary description of the subject matter and then elaborate on the importance of this case report. Providing a brief overview of the up-to-date literature will help readers understand why this case is worth publication and dissemination. However, the most detailed and thorough review should be reserved for the discussion. Finally, introduce the patient case to the reader. The introduction is meant to be a concise preview to attract your reader further into the case.3 This section aims to present all pertinent details of the patient case.1 Narrating the presentation in chronological order typically offers the reader the clearest understanding. This section will include pertinent demographics (age, gender) and initial presentation pertinent to the case (medical history, family history, surgeries, allergies, vaccines, medications, and social history). Highlighting additional pertinent positives or negatives specific to gastroenterology such as any herbal supplements, dietary practices, stool pattern, and nonprescription medications should be considered. If pertinent to the case, it is important to include details of the medications discussed such as dosage, route, past adverse reactions, drug levels, dates of administration, and adherence.9 Generic names for medications should always be used.1 Clinical encounters can be documented by pertinent physical exam findings, laboratory values, outcomes of diagnostic procedures, and imaging. It is essential to include normal ranges when describing laboratory values. Additionally, providing photographs of relevant imaging, histopathology, endoscopy findings, exam findings, and so on, can enhance the case description.4 Patient consent must be obtained for any images used and the protection of patient identity must be preserved.4 It is crucial to follow institutional guidelines when obtaining permission from the patient.1 While images can help illustrate major findings, they come with additional considerations for authors.4 Images need to fit in line with the text and, for grouped pictures, they need to adopt a uniform size and distribution within a section. Authors are encouraged to use editable image formats to ensure that all final products remain in focus after final editing, especially when describing pathology and use of arrows or guides can quickly focus readers.10 Lastly, all images should include a caption consisting of a brief title and description of the image.10 The overall case description should establish a clear timeline with sufficient detail to substantiate the relationship between events and outcome. This will naturally raise the research questions to be discussed in the following section.4 This section is important to summarize key points, compare the case with current literature, draw conclusions, and present recommendations.9 Often highlighted in this section is an extensive literature review, justifying the validity of this case report. Authors often contrast nuances and differences with known publications to justify the uniqueness of the case.3 It is also important to list limitations and their relevance.1 This is the final space to summarize the take home points, conclusions, and promote the future investigation. Recommendations should be evidence based and authors should emphasize how they apply to current practice.4 In conclusion, case reports are a time-honored and vital aspect of medical literature.3 Although they do not provide the same level of evidence as randomized control trials or systematic reviews, case reports remain an important avenue for sharing new medical information captured in unique cases.1 In addition to enriching our collective medical knowledge, case reports are a great learning tool for gastroenterology fellows.6 They promote the professional development, writing ability, and communication skill of their authors.4 This up-to-date resource will provide health practitioners with a step-by-step guide to successful publication. The authors have no funding to report. The authors declare no conflict of interest.