A case report is short, but it falls apart quickly when consent is missing, the timeline is vague, or the discussion claims more than one patient can show.
What a case report has to do
A case report describes one patient's medical problem and its management so that other clinicians can learn from it. It is short, but it is less forgiving than it looks. There is no sample size to hide behind: every missing dose, undated test or unexplained change in treatment is visible to the reviewer.
The standard framework is the CARE checklist, a 13-item reporting guideline for case reports first published in 2013 and supported by a 2017 explanation and elaboration paper in the Journal of Clinical Epidemiology. It covers everything from the title to informed consent.
The CARE group's own writing advice makes a point worth taking seriously: it is easier to write the sections in a different order from the one in which they are published. The seven steps below follow that working order.
Step 1: Confirm the case has a lesson
Start by deciding what the report is actually about. CARE's guidance frames the choice as an outcome, a diagnostic assessment, an intervention, a new or rare disease, or something else. Historically, case reports have been important for recognising new or rare diseases, for evaluating the benefits and harms of interventions, and for medical education.
Then test the idea with one sentence:
Clinicians who see [situation] should [consider, test for, or avoid] [X], because this case shows [Y].
If you cannot finish that sentence honestly, the case may be better suited to a teaching round than a journal. Rarity on its own is a weak argument unless it changes what someone would do.
Before you write anything else, search the literature for earlier reports of the same diagnosis, presentation or intervention. Record your search terms, databases and date. You will need them in the discussion, and they are what makes any claim of novelty defensible. If similar reports exist, your sentence has to say what yours adds.
Step 2: Secure consent and settle ethics requirements
Do this before drafting, not the week you submit. The CARE group's writing advice notes that it is often best to ask for informed consent, and for the patient's perspective, before you begin writing.
Consent for publication. The ICMJE recommendations on protecting research participants say identifying information should not be published unless it is essential and the patient, parent or guardian gives written informed consent. They also say:
- an identifiable patient should be shown the manuscript to be published
- nonessential identifying details should be omitted
- consent should be obtained if there is any doubt that anonymity can be maintained, and masking the eye region in a photograph is not adequate protection
- if you alter details to de-identify a patient, you should give assurance that the changes do not distort the scientific meaning
- the published article should state that consent was obtained
COPE's guidance on consent for medical case reports adds that consent forms should be required whenever a person could be identified, including in reports about deceased patients. It lists what a good form covers: that the journal cannot guarantee anonymity, that consent can be withdrawn before publication but not after, whether the patient has seen the final version, and how the report will be distributed. Where a patient cannot consent, such as a young child or a person without capacity, a proxy signs and the form records why.
Some journals require their own consent form even if you already hold a signed one, so identify your likely target journal early. Where the signed original is kept also varies: follow the journal's instructions and your institution's rules.
Ethics approval. This is a separate question, and the answer depends on where you work. COPE Council advice on a member case notes that some ethics committees, institutions and governments do not regard reporting a single case from routine care as research, while cases from an efficacy study or trial usually are. It adds that committees may apply a patient-number cut-off above which a case series counts as research.
The practical rule: email your ethics committee or IRB, describe the report, and keep their written answer.
| Question | Consent for publication | Ethics approval |
|---|---|---|
| What it covers | Publishing details about a person who could be identified | Whether the work counts as research needing review |
| Who gives it | The patient, or a proxy with the reason recorded | Your ethics committee, IRB or institution |
| When it is needed | Whenever identification is possible | Varies by institution and country |
| What the paper states | That written consent was obtained | Committee and reference number, or that approval was waived or not required |
Step 3: Build the timeline
CARE item 7 asks for the episode of care organised as a timeline, and the CARE group recommends creating it before you write the narrative. A timeline set out as a table or figure lets a reader see the whole case at a glance, and building it exposes gaps in the record while you can still fix them.
A case report template for the timeline:
| Time from presentation | Event | Key findings or results | Intervention or change |
|---|---|---|---|
| Before presentation | Relevant history | Prior diagnoses, family history | Past treatments and response |
| Day 0 | Presentation | Main symptoms, examination findings | None yet |
| Days 1–3 | Investigations | Results, differential diagnoses considered | Initial treatment with dose and route |
| Week 2 | Change in course | New findings | What changed, and why |
| Month 6 | Follow-up | Outcome, adverse events or their absence | Ongoing management |
Express time relative to presentation rather than as calendar dates. Admission and discharge dates appear in the US list of patient identifiers reproduced in the CARE explanation paper, and relative time is usually clearer to read anyway.
If the records lack a dose, a result or a follow-up visit, retrieve it now. If it cannot be retrieved, note it for the limitations paragraph rather than filling the gap from memory.
Step 4: Write the case in CARE order
With the timeline done, the case narrative is mostly a matter of turning rows into prose. Use CARE items 5 to 10 as your case report format (item 7 is the timeline you have already built):
| CARE item | What to write | Watch for |
|---|---|---|
| 5. Patient information | De-identified details, main concerns and symptoms, medical, family and psychosocial history, relevant past interventions | Details that identify without informing |
| 6. Clinical findings | Significant examination and clinical findings | Normal findings that matter, left out |
| 8. Diagnostic assessment | Tests, diagnostic challenges, the diagnosis with other diagnoses considered, prognosis where relevant | A diagnosis with no differential |
| 9. Therapeutic intervention | Type of intervention, dosage, strength and duration, changes with the reason | A drug name with no dose, route or duration |
| 10. Follow-up and outcomes | Clinician- and patient-assessed outcomes, follow-up results, adherence and tolerability and how they were assessed, adverse events | Silence on adverse events |
Two details are easy to miss. First, the CARE explanation paper says every case report should explicitly state whether adverse events occurred, so write "no adverse events were observed" when that is true. Second, describe drugs by their international nonproprietary name with the dosing regimen and duration, and give enough detail on any intervention for someone else to reproduce it.
Step 5: Write a discussion that does not overclaim
CARE item 11 has four parts, and it helps to write them as four short blocks:
- Strengths and limitations of the case and how it was managed.
- The relevant literature, including the reports your Step 1 search found.
- The rationale for your conclusions, including which other causes you considered and why you judged them less likely.
- The take-away lesson, in a one-paragraph conclusion without references.
The main risk here is claiming too much. A single case usually cannot exclude chance association, and the CARE explanation paper recommends saying plainly that results from one patient may not apply to patients in general.
| Instead of | Write |
|---|---|
| "Drug X caused the reaction" | "The timing is consistent with drug X; we considered [alternatives] and judged them less likely because…" |
| "This is the first reported case" | "A search of [databases] on [date] found no previous reports of…" |
| "Treatment X should be used" | "This case suggests treatment X merits further study in…" |
Step 6: Add the patient perspective, abstract and title last
Patient perspective (item 12). Where possible, the patient shares their experience of the treatment in one to two paragraphs. You should already have asked for it during Step 2. If the patient is also a co-author, check the journal's consent requirements, because their anonymity is lost.
Abstract (item 3). Write it last so it matches the finished report. CARE asks for what is unique about the case, the main symptoms and findings, the main diagnoses, interventions and outcomes, and the take-away lesson, with no references. Structured versions typically use three headings: introduction, case presentation and conclusion.
Title and keywords (items 1 and 2). Name the diagnosis or intervention of primary focus, followed by the words "case report", for example: "[Diagnosis] presenting as [unusual feature]: a case report". Add two to five keywords, including "case report", unless the journal sets its own range.
The CARE explanation paper also recommends a sentence stating that the report was prepared following the CARE guidelines, with a citation to the CARE statement.
Step 7: Match the journal's format
CARE describes what to report, not how a journal lays it out. Before you finalise, open the target journal's instructions for authors and check:
- whether it publishes case reports at all, and under which article type
- its limits on words, references, figures and authors, which vary widely between journals
- whether it wants the completed CARE checklist uploaded, with the location of each item filled in
- whether it names a different checklist, such as SCARE for surgical case reports
- its wording for the consent and ethics statements
Take care with journals that focus on case reports: the CARE explanation paper itself notes that some newer ones came from publishers labelled predatory. Our guide to choosing the right journal without getting scammed walks through the checks.
Settle authorship before submission too. The ICMJE authorship criteria apply to case reports as to any other article, and caring for the patient does not qualify someone on its own; colleagues who contributed without meeting all four criteria belong in the acknowledgments. ORCID, affiliations and authorship covers the basics.
Before you submit
- One-sentence lesson stated in the introduction and conclusion
- Signed consent on the journal's form, stored as the journal requires
- Written ethics determination, with the statement worded for the journal
- No names, initials, hospital numbers or calendar dates, and no identifiable images without specific consent
- Timeline included as a table or figure
- Doses, durations and changes in treatment reported with reasons
- Adverse events stated as present or absent
- Limitations and alternative explanations discussed
- Title names the focus and ends with "case report"
- CARE checklist completed if the journal asks for it
For the general submission steps that apply to every article type, use your first manuscript submission checklist.
A well-reported case is short, specific and honest about what one patient can show. Directive Publications brings its author guidance, publication ethics and open-access policies together on its For Authors page, so you can confirm what your target journal expects before you finalise the consent and ethics statements.
Frequently asked questions
Do I need patient consent to publish a case report?
In practice, yes. ICMJE recommends written informed consent before publishing identifying details, and says consent should be obtained if there is any doubt that anonymity can be maintained, which is a real risk with an unusual presentation. COPE advises that consent forms be required for any case report in which a person could be identified, including reports about deceased patients. Use the target journal's own consent form if it has one.
What makes a case report worth publishing?
A case is worth publishing when it teaches something another clinician can use: a new or rare condition, an unusual presentation, an unexpected benefit or harm from a treatment, or a diagnostic lesson. Rarity on its own is a weak argument unless it changes what someone would do. Search the literature for similar reports first, and make sure you can state in one sentence what your case adds.
Does a case report need ethics committee approval?
It depends on your institution and country. COPE Council advice notes that some ethics committees, institutions and governments do not treat reporting a single case from routine care as research, while cases from a trial or efficacy study usually are. Ask your ethics committee or IRB for a written answer, then state in the manuscript either the approval and reference number or that approval was waived or not required. Consent for publication is still needed either way.
How long should a medical case report be?
There is no universal length, because the limit is set by the journal, and case report limits on words, references, figures and authors vary widely. The CARE checklist sets proportions rather than totals, such as one or two paragraphs for the introduction and a one-paragraph conclusion. The CARE explanation document notes that abstracts customarily run from 100 to 250 words depending on the journal.
Who should be listed as an author on a case report?
The ICMJE authorship criteria apply to case reports as to any article: a substantial contribution to the work or its data, drafting or critically revising it, approving the final version, and agreeing to be accountable for it. Caring for the patient does not by itself make someone an author, so colleagues who do not meet all four criteria should be acknowledged, with their permission. Some journals also cap the number of authors on case reports, so check before you finalise the byline.