Case reports and case series – why publish clinical cases: advantages and limitations

The case report has the dual purpose of describing the diagnostic-therapeutic process of a particular patient and sharing this clinical experience with other health professionals.

Not all scholarly journals accept case reports: the case must be really of particular interest to be taken into consideration: for example, it may concern an unknown, rare or unusual pathology, a complication never previously described in the literature, a new procedure diagnostics or combination of treatments.

Topics addressed by journals accepting case reports may include previously unreported adverse effects caused by drugs or other treatments, unexpected events occurring in the course of observation or treatment of a patient, observations on the pathogenesis of the disease, presentations and/or management of new and emerging diseases, new therapies or therapeutic approaches, ethical challenges in patient management and strategies to prevent or overcome errors in the clinical setting.

The main advantages of publishing a case report are therefore related to the ability to make new observations, generate hypotheses, accumulate scientific data on rare disorders, contribute to drug safety surveillance (pharmacovigilance) and serve as an important educational tool that can raise awareness among readers and thus facilitate the identification of similar cases. Without neglecting the fact that the case reports could enrich the set of evidence capable of modifying the risk-benefit ratio of a drug.

Case reports and case series - why publish clinical cases: advantages and limitations

There are numerous examples of new discoveries or major advances in medicine that began following the publication of a case report; for example, the first evidence of congenital anomalies related to the use of thalidomide appeared as a case report in 1961 in The Lancet.

The main limitations of a case report refer to the limited possibility of generalizing the validity of the study and the impossibility of establishing a cause-effect relationship. In addition, there may be major biases regarding publication, retrospective study design, and focus on rare or unusual cases. In the pyramid of evidence, case reports and case series are considered contributions based on a much lower level of reliability than meta-analyzes, systematic reviews, randomized clinical studies and other types of observational studies. Therefore their use and interpretation must be carefully considered, within a much broader context, in order to prevent any unneccessary overstatement of the validity of the study.

A Springer Nature Writing Case Reports: a practical guide from conception through publication analyzes in detail all the phases for writing this type of content.

The explosion in the number of journals dedicated to clinical cases

The number of peer-reviewed journals focusing on case reports has increased exponentially, with hundreds of publications and publishers launching new publications. The trend has further increased with Open Access. Most of the case reports are open access, but only a small percentage are indexed in PubMed.

The typical structure of a case report

Referring to an unusual, rare, or new condition is strongly advised. A complication of a rare or unusual disease or therapeutic procedure may be considered for a case report. However, rarity in itself does not represent a sufficiently valid reason for the acceptance of a manuscript. The case must be very specific and offer an educational message to the reader: providing new information on the pathology, facilitating future diagnoses, offering a more suitable or effective line of treatment.

How to evaluate the quality of a case report? What are the guidelines for writing a case report?

The CARE Guidelines (CAse REports) were developed by an international group of experts with a view to improving the accuracy, transparency and usefulness of case reports. The CARE checklist is useful both for assessing the quality of a manuscript illustrating a case report and as a reference point for writing a manuscript which presents a clinical case.

Care Writer, a free online tool, allows authors to use an online support for the drafting of the manuscript in order to adequately structure the contents without neglecting any of the essential points.

Springer Healthcare Italia offers Medical Writing support services to groups of clinicians and healthcare professionals to support the drafting of case reports and case series.

Real World Data also includes Case Reports

Real World Data (RWD) is health data collected outside the scope of traditional clinical trials, including patient retrospective data (e.g. electronic health records, administrative data, registries, data generated by patients through wearable sensors, patient measurements social determinants of health and environmental exposures, etc.) and prospectively collected data (e.g. interventional studies, observational research, etc.). Real World Data can also include case reports. Real World Evidence (RWE), on the other hand, refers to the evidence generated by the application of appropriate analytical methods based on real world data.

Over the last few years, the pharmaceutical industry has begun to explore new methodologies for the optimization of RWDs: companies that develop medicines for rare and orphan therapies must be able to document the value of the product to all stakeholders in the supply chain, even beyond beyond clinicians and patients, in particular as regards the decision-making on the regulation of the use of the drug, on the price and reimbursement and access to the market.

Also for the reporting of real world data, the STaRT-RWE checklist is available which can be of help to researchers both in the critical evaluation of RWD-based papers and as a reference for the drafting of a structured manuscript on these data.

Open Access, Article Processing Charges and predatory editors

The exponential increase Open Access Publishing has certainly favored many researchers by allowing a much broader, unlimited and more efficient use of schoarly articles for the benefit of a wider audience, especially users who would not be able to benefit from such free content.

The first Open Access Publisher, BioMed Central (now part of the Springer Nature group, was launched in 200, initially with 231 articles published that year and 60 journals). During 2020, Springer Nature published over 124,000 open access articles (representing approximately 33% of SN published that year). Such figures confirm SN as a leader in publishing Open Access Journals, together with hybrid and toll access periodicals.

In parallel to content published by reputable organisations, however, hundreds of journals publishing articles regardless of any peer review process only because a payment is made (APC: what are they?) have been proliferating. It is essential to remember that APCs must be paid only after the peer review process is completed and not before. They should not guarantee the acceptance of the manuscript upfront, but only cover the management costs for the peer review process. Predatory publishers often manage to deceive even experienced researchers and academics, by inviting them as editorial board members. Most of the journals of “predatory” publishers do not publish specific APC fees, do not pursue an effective and serious peer review process and in some cases even use researcher names as authors in manuscripts without their knowledge.

Specifically for case reports, predatory publishers represent a serious reputational threat as well as economic damage both for the scientific community and for any serious publisher. In case of doubt, it is always advisable to refer to the COPE (Committee on Publication Ethics) Code of Conduct and Principles of Transparency and Best Practices in Academic Publishing as well as to the guidelines of the Open Access Scholarly Publishers Association (OASPA) and the World Association of Medical Editors.

How to identify a journal in order to submit a case report or a case series?

The Harriet F. Ginsburg Health Sciences Library of the University of Central Florida provides a very useful prospectus in order to identify indexed journals (with or without impact factor) for a variety of publishers, with useful details to better understand the type and format of the content which is expected.

Another tool available to authors is the Edanz website, which allows you to make a quick seamless cross sectional selection though the catalogues of different publishers (seach can also be performed by keyword).

Springer Nature publishes many high quality journals considering case reports and case series, such as BioMed Central’s Journal of Medical Case Reports.

Alessandro Gallo


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