By their nature, case reports are very compelling to the enquiring mind—almost like the gossip columns of the medical literature. Like gossip columns, case reports draw fascinating new connections using a litany of supporting data and observations, including photographic evidence. However, case reports have more rigorous reporting requirements, including peer review, and are (arguably?) more vital to human wellness. In a presentation to Roseman College of Pharmacy faculty on June 2, 2022, Henry Cohen, Dean and Professor at Touro College of Pharmacy in New York, shared examples of seminal case reports that ended up having a major medical impact. These included the first descriptions of what would later be called HIV/AIDS, the association of clindamycin with C. difficile diarrhea, and the connection between ACE inhibitors and cough. His presentation went on to describe how pharmacy faculty can identify and publish worthwhile case reports.
Identifying a Case
At certain points in his presentation, Dr. Cohen drew attention to ideas for cases that journals might find interesting (e.g., hepatotoxicity caused by statins, prednisone-induced rash, etc.) but recommended that any novel or rare case be considered for a report. Adverse effect or medical error data on drugs, vaccines, or devices, especially those that are newly approved, are often good sources of ideas for case reports. A case of angioedema of the hands induced by an ACE inhibitor was provided as an example of a report on a novel adverse effect. Investigators may find that working together with students, residents, physicians, and other members of the healthcare team can help in not only identifying potential case reports but also in establishing mutual accountability to get them published.
Writing the Case
Dr. Cohen counseled potential authors to provide as many clinical details as possible in their reports, including thorough patient histories, demographic data, vaccinations, medication history (including OTC, herbal, and recreational drugs), diagnostic data, lab values, results of physical examinations, history of drug reactions, dietary history, and so forth, sufficient to establish a causal relationship and eliminate other viable alternatives. In doing so, authors were cautioned to avoid releasing data that may give away the patient’s identity, such as the use of patient initials, birth date, or exact dates of admission. Relevant photography was highly recommended, with several examples provided, including one that illustrated a case of extreme gingival hyperplasia induced by phenytoin. However, researchers were urged to gain all necessary permissions to take patient photos and to crop or cover features that may identify the patient.
In his experience, Dr. Cohen has found most institutional review boards will grant exempt status to case reports, but advised researchers to consult the IRBs of their university and practice site for specific policies. He likewise recommended notifying one’s hospital pharmacy director and college administrative supervisor about the proposed work to obtain any necessary approvals.
Publishing the Case
Dr. Cohen mentioned that, of an estimated 170+ pharmacology-related journals, most will publish case reports, and he provided a list of some of the more prominent pharmacy and medical journals that do so. He also noted that sometimes investigators will publish brief case reports in letters to the editor. In seeking a place to publish their work, authors should be careful to avoid journals that engage in predatory and deceptive practices. To gain experience and perspective, Dr. Cohen recommended volunteering as a peer reviewer for a reputable journal in your area of practice.
The following were recommended as good general resources for those desiring further information on writing case studies:
- McCarthy LH, Reilly KE. How to write a case report. Fam Med. 2000;32(3):190-195.
- Cohen H. How to write a patient case report. Am J Health Syst Pharm. 2006;63(19):1888-1892.
- Stokes V, Fertleman C. Writing a case report in 10 steps. BMJ. 2015;350:h2693.
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Tyler Rose, Ph.D.
Associate Professor of Pharmaceutical Sciences
Roseman University of Health Sciences College of Pharmacy