How to structure a case report in dermatology?

"Case report is a distinct way of conveying a piece of information. In addition, writing a case report provides a good opportunity to young physicians to get acquainted with the nitty gritties of writing a scientific article. Case reports have more chances of acceptance if they provide a message which has the ability to alter clinical practice. They are also accepted if they add to the existing literature and/or raise a novel research question, which has the potential of generating a large-scale research.

A case report is expected to be authentic and thought provoking. The use of propranolol for the management of infantile hemangiomas is an example; which came into limelight with the publication of case reports; and thereafter, large-scale experimental studies were designed. Therefore, case reports aid in designing tenable protocol for performing good quality scientific research. The CARE (CAse REport) guidelines for writing a case report are universally followed.

Brevity and clarity, are the two pre-requisites for any case report. The various components of a case report and the preferable formatting of the same have been summarized below:

Title: Authors should attempt to provide a short and crisp title, and ensure that the title attracts the reviewers, editors, and the readers, to go through the entire article. The title should be well-thought of and comprehensive. It should always give a fair idea of what lies within the article, and should not be vague and non-specific. The new message of the article should preferably be reflected in the title. Most importantly, the title should be scientifically sound. Abbreviations in the first place should be avoided, and authors should avoid the use of “superfluous words”.

Abstract: The abstract must clearly state the new information and the key takeaway messages. There should be adequate patient data in terms of relevant history, clinical findings, tests, and interventions. Both physician and patient assessed outcomes should be mentioned. Abstract is one of the most crucial components of an article, because, the reviewers and the editors would be having a fair perception of the entire manuscript after reading the abstract, and many times, the articles get rejected due to a poorly written abstract (lack of flow and message). Abstract should be revised every time the manuscript is revised or changed.

Keywords: Choosing a proper keyword is very important, while writing a case report. Keywords aid the indexers and search engines find relevant papers. Keywords should represent the content of the manuscript, and should be specific to the entity in question

Introduction: Introduction of a case report must initially address the magnitude and importance of the disease in question. Authors should highlight as to what is unknown about the entity and why they are reporting the case.

Case report: This section should describe all the necessary details of the patient including de-identified patient-specific information, concerns, and symptoms, relevant history (medical, surgical, and family), significant clinical examination findings (both positive and negative), diagnostic tests, differentials, provisional diagnosis, and prognosis. Authors should always mention how they ruled out the clinical and histpathological differentials (preferably in a tabular format) and how they arrived at the final diagnosis. If applicable, authors should also describe the details of therapeutic intervention (pharmacological name of drug, dose, frequency and duration). The response to treatment (objective and subjective parameters) must be mentioned clearly, without any ambiguity. When the authors are reporting a drug reaction, it is advisable to mention the details of Naranjo's adverse drug reaction probability scale, Hartwig's severity assessment scale and modified Schumock and Thornton scale. Besides, it is prudent to register the drug reaction under Pharmacovigilance Program of India (PvPI) and mention the necessary details about the same, in the case report.

Discussion: The discussion should include the relevant medical literature and the rationale for the conclusion. It is always advisable to add the perspective of the patients, whenever possible. A thorough literature search must be done and the relevant references must be cited. Some widely used reference management and formatting software applications are BibTeX, Papers, Zotero, EndNote, RefWords, ReadCube, and Mendeley. Authors should always avoid the claims the first publication, because this is not possible to be verified by the reviewers and editors, and such claims are not desirable while publishing any article. Authors should summarize the key findings and unique points about their case, highlighting the need for publishing the case report (as to how this will add to the literature). The primary take-away messages of the case report should be given at the end of the article, in the form of a one-line conclusion.

Images and figures: The requirements are always mentioned in the website of the journal. Some of the vital considerations include a non-identifiable patient, high-quality JPEG or TIFF-centered clear and sharply focused images, and not exceeding 3-4 MB. Authors should never crop the original image, and ensure that the background is clean. If the figure has been published before, authors should acknowledge the original source and submit written permission from the copyright holder to reproduce the material. A credit line should appear in the legend for such figures. Low-resolution images, grainy images due to high ISO and pixelated images should never be submitted. The photographs must be clicked in a manner that makes it clear to the readers, as to which region is involved. If the authors are describing a case whose uniqueness lies in the unilateral distribution of lesions on the lower limb, the photograph must be clicked in a fashion which displays both the lower limbs. When it comes to therapeutic interventions, the pre-treatment and post-treatment photographs should have the same resolution, exposure, brightness and background. The figure legends must precisely mention about the stain and magnification for dermatopathology images; and the type of dermoscope used (and the magnification)."

Adil Maqbool

Hello Thiago,

In this case report, the most important thing is "end-impact". First of all, analyze the case, explore the relevant medical literature and figure out how this case report can impact the existing literature and what benefits others can get through it.

Once you will know the answer, that will be your Report question and conclusion, mount the rest of the case around it and you will end up with a very high-quality case report.

If you still need any assistance, inbox me and I'll further help you.

Best,

Dr. Adil

Joseph C Lee

Hello Thiago Soethe Ramos

I agree with Dr Adil Maqbool to start with that the underlying message of the report is essential and you need a clear idea before you start writing.

My personal approach is that the first part is the case. I would say about the presentation, the differential diagnoses (and how each was eliminated) and what tests and investigations helped resolve the problem.

The second part for me would be a discussion, including comparison/correlation to relevant literature.

There are, as r Sundus F Hantoosh mentioned, specific requirements for each journal (regarding word count, graphics - format, resolution and so on) that you should obey. It would be such a shame if your work was rejected just for that reason.

Thiago Soethe Ramos

DRs Joseph C Lee , Adil Maqbool and Sundus F Hantoosh

So, doctors.

I'm accompanying the patient, and I'm writing a very consistent text in the most current scientific literature. as this is a "common" case of severe atopic dermatitis in an adult male patient; the text is getting long, since each laboratory result has been given a brief description and justification, and for each clinical decision-making I have done the same way. I am also doing very dense approaches within the immunopathology of the case. Do you think that due to the size of the manuscript it will cause me problems regarding submission to a journal?

Dear Thiago,

You are on the right track. In the first draft, include all possible information, relevant content, and labs or important information regarding the case. Don't worry about the manuscript size (because you will trim it down later on)

Once you have everything, then the next step (the most crucial one) will be the trimming of the existing large-size manuscript to the standard case report, and for that you must have enough experience to know "what needs to be retained and what's to be removed."

That will highly depend on the case question/outcome of your report.

Hope it helps you. Still, if you need any assistance, inbox me, and I'll guide you.

Frederic Vellieux

Start by writing and providing ideas of what you think is "your" way of structuring the report. Once you have a good piece of text, use ChatGTP (feed it your manuscript perhaps two pages at a time) to get ideas of how to improve it. Improve the MS, then again go to ChatGTP etc. Don't believe everything that ChatGTP will provide though.

Anahita Vali

Hi Thiago

I agree with Dr Maqbool but I think the exact writing about the signs and symptoms even when you don't know what is the impact of your report on human knowledge have many values.

If your common sense say you there is something strange in my case just writing about details and take high quality photos.

Good luck

Anahita Vali THAT'S WHAT I'M DOING WRITING EVERYTHING. EVERY REPORT. EVERY INFORMATION, EVERY MOVEMENT. THEN I ANALYZE BUT NOW I'M TREATMENT TAKING CARE OF MY DATA AND MY PATIENT. AT THIS MOMENT I CONSIDER THAT TAKING CARE OF MY PATIENT AND FAMILY (ATOPICAL FAMILY), I CONSIDER THIS MOMENT FUNDAMENTAL

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