A case report is a detailed account of a single patient’s diagnosis, treatment, and outcome, published to share unusual or instructive clinical experiences with the medical community. Writing one well requires a specific structure, adherence to patient privacy rules, and a clear argument for why your case matters. The CARE (CAse REport) guidelines provide a 13-item checklist that most journals now expect authors to follow.
Start With the Timeline, Not the Narrative
Before you write a single sentence, build a chronological timeline of your case. This is the step most first-time authors skip, and it’s the one that makes everything else easier. The CARE guidelines recommend creating a visual summary, either a figure or a table, that maps out every visit, test, intervention, and outcome in the episode of care. Dates on one axis, clinical events on the other.
This timeline serves two purposes. First, it becomes a figure in your published report, giving readers a quick overview of the entire case at a glance. Second, it acts as your outline. Once the chronology is clear, writing the narrative sections becomes a matter of expanding each entry into prose. You’ll also catch gaps in your documentation early, before you’ve written 2,000 words around a missing lab result.
Structuring the Report Section by Section
Title and Keywords
Your title should name the primary diagnosis or intervention and end with the words “case report.” Keep it specific enough that a researcher scanning search results can immediately tell what the case involves. Choose 2 to 5 keywords that capture the diagnoses or interventions, and include “case report” as one of them. This is straightforward, but getting it right improves your discoverability in databases like PubMed.
Abstract
Most journals accept either a structured or unstructured abstract. A structured abstract uses labeled sections (typically Background, Case Presentation, and Conclusions) while an unstructured abstract covers the same ground in paragraph form. Check your target journal’s guidelines, since abstract format varies. Either way, the abstract should tell the reader what the case is, what happened, and why it’s worth reading, all in roughly 150 to 250 words.
Introduction
The introduction is short, often just two or three paragraphs. Its job is to answer one question: why does this case deserve to be published? Briefly establish the medical context. Cite existing literature to show what’s already known, then identify the gap your case fills. Maybe the condition is rare, the presentation was atypical, or the treatment approach was novel. Whatever the reason, state it clearly. A vague claim that the case is “interesting” won’t survive peer review.
Patient Information
Open with the patient’s demographic details (age, sex, relevant background) in de-identified form. Then describe their primary concerns and symptoms in their own terms when possible. Include medical history, family history, and psychosocial history that’s relevant to the case. If the patient had prior treatments for the same condition, note what those were and how they worked. This section sets the stage for everything that follows, so be thorough but stay focused on details that matter to the clinical narrative.
Clinical Findings and Diagnostic Assessment
Describe the significant findings from physical examination, then walk through your diagnostic process: what tests you ordered, what the results showed, and what diagnoses you considered. This is where you lay out the differential diagnosis. Don’t just present the final answer. Show the reasoning that got you there, including diagnoses you ruled out and why. If there were diagnostic challenges (ambiguous imaging, conflicting lab results, unusual symptom patterns), describe them honestly. Readers learn as much from the diagnostic journey as from the destination.
Therapeutic Intervention
Detail every intervention: pharmacologic, surgical, preventive, or lifestyle-based. For each one, specify the type, dosage, strength, duration, and frequency. If you changed the treatment plan at any point, explain what prompted the change. Tables work well here when the treatment course is complex or involves multiple adjustments over time. Be precise enough that another clinician could understand exactly what was done.
Follow-up and Outcomes
Report both clinician-assessed and patient-assessed outcomes. Include follow-up test results, how well the patient adhered to treatment, whether they tolerated it, and any adverse or unanticipated events. Specify the follow-up duration. A case report that ends at discharge without follow-up is incomplete, and “incomplete conclusion” is one of the most common reasons journals reject case reports.
Patient Perspective
This section is unique to case reports and often overlooked. The CARE guidelines ask you to include the patient’s own perspective on their treatment. A few sentences from the patient about their experience, what helped, what was difficult, what they noticed, adds a dimension that clinical data alone can’t capture. It also signals to reviewers that you engaged the patient as a partner in their care.
Writing the Discussion
The discussion is the most important section of a case report. It’s where you move from describing what happened to explaining what it means. A strong discussion does five things: evaluates the case for accuracy and uniqueness, compares and contrasts your findings with the published literature, derives new knowledge or insights, summarizes the essential features of the report, and draws practical recommendations.
Start by acknowledging the strengths and limitations of your approach. Every case report has limitations (it’s a single patient, after all), and naming them honestly strengthens your credibility. Then situate your case in the existing literature. How does this patient’s presentation, diagnosis, or outcome compare with previously published cases? Where does your experience confirm what’s known, and where does it diverge?
End the discussion with a one-paragraph conclusion that captures the primary “take-away” lessons from your case. This paragraph should stand on its own without references. Write it as if you’re telling a colleague: here’s what this case teaches us and why it matters for clinical practice.
De-identifying Patient Information
Patient privacy isn’t optional, and getting it wrong can block publication entirely. Under the HIPAA Safe Harbor method, you must remove 18 specific identifiers before submitting your report. The obvious ones include names, phone numbers, email addresses, and Social Security numbers. But the list also covers details authors frequently miss: all geographic information smaller than a state (including city and ZIP code), all date elements except year (birth dates, admission dates, discharge dates), medical record numbers, health plan numbers, and device serial numbers.
Ages over 89 require special handling. You must aggregate them into a single category of “90 or older” rather than listing the specific age. Full-face photographs and comparable images are explicitly listed as identifiers, so any clinical photos must be cropped or obscured to prevent recognition. Even if your patient consents to publication, most journals still require de-identification as standard practice.
The simplest way to check your work: read through your manuscript and ask whether any combination of details could allow someone to identify the patient. A 47-year-old woman is anonymous. A 47-year-old woman treated at a named hospital in a small town in March 2023 may not be.
Informed Consent
You need written informed consent from the patient (or their legal guardian) before submitting a case report for publication. Most journals require you to state in the manuscript that consent was obtained, and some will ask you to provide the signed consent form during the review process. Get consent early, ideally while the patient is still in your care, rather than trying to track them down months later when you decide to write the case up.
Common Reasons Case Reports Get Rejected
Peer reviewers and editors reject case reports for a handful of recurring problems. The most frequent is that the case simply isn’t unique. If dozens of similar cases already exist in the literature and yours doesn’t add a new angle, it won’t find a home. Before you invest weeks of writing, do a thorough literature search to confirm your case genuinely contributes something new.
Other common rejection reasons: the patient was mismanaged within the accepted standard of care (meaning reviewers see a clinical error rather than a learning opportunity), the differential diagnosis is incomplete or formatted incorrectly, no final diagnosis is provided, and the case ends without a clear outcome. That last point is worth emphasizing. Reviewers want to know what happened to the patient. A case report that trails off without resolution feels unfinished and gets treated that way.
Choosing a Journal and Formatting
Not every journal publishes case reports, and those that do often have specific formatting requirements. Some require structured abstracts with labeled sections, others accept unstructured paragraphs. Word limits for the full manuscript typically range from 1,500 to 3,000 words, though dedicated case report journals may allow more. Check whether your target journal follows the CARE guidelines (many now require CARE checklist compliance as a condition of submission) and download their author instructions before you start formatting.
Dedicated case report journals like BMJ Case Reports, Journal of Medical Case Reports, and Cureus have higher acceptance rates for well-written cases than high-impact general medical journals, where case reports compete with large clinical trials for limited space. If your case is instructive but not groundbreaking, a specialty or case-report-focused journal is often the better fit.