The Educational Value of Case Reports
Case reports can produce substantial educational benefits. Readers of case reports gain a deeper understanding of the topic area and key insights into specific points of diagnosis and management. Case reports also create “recognition patterns” that reader
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Educational Benefits of Reading Case Reports A case report is a clear, concise, and digestible account of a case that can easily be read in one sitting. It offers much more than a description of a unique or unusual patient encounter. A well-prepared case report gives a focused review of the pertinent literature, places the case in context compared with other similar cases, proposes a hypothesis to explain what occurred, and makes a clear teaching point. The attentive reader will gain both deeper understanding of the topic area and insight into specific points of diagnosis and management. Consider, for example, a case report written by one of my former medical students describing an unusual case of airway compromise in infectious mononucleosis [1]. We learn that infectious mononucleosis can, in rare cases, cause lifethreatening airway obstruction due to severe tonsillar hypertrophy, with the key findings of “hot potato voice” and “kissing tonsils” on CT imaging of the neck (Fig. 3.1). In addition, we learn that the differential diagnosis for pharyngeal airway obstruction also includes peritonsillar abscess, epiglottitis, Ludwig’s angina, angioedema, foreign body, neoplasm, and local trauma. A literature review reveals that only 5 of 467 mononucleosis patients in one series had airway © Springer International Publishing Switzerland 2017 C.D. Packer et al., Writing Case Reports, DOI 10.1007/978-3-319-41899-5_3
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Chapter 3. The Educational Value of Case Reports
Figure 3.1 CT image of “kissing tonsils” [1]
compromise, that most patients with it respond well to corticosteroids, and that very few require tonsillectomy. Finally, the author clearly delineates the clinical reasoning that led to the diagnosis: While this patient already carried a diagnosis of infectious mononucleosis, we could rule out diphtheria as there were no significant pharyngeal exudates and he had been previously vaccinated. Direct visualization of the pharynx with laryngoscopy revealed no foreign bodies, neoplasms, abscesses, and revealed only tonsillar swelling. Cultures for superimposed streptococcus infection were negative. Taken together, these diagnostic findings further confirmed that this patient’s symptoms were due only to infectious mononucleosis without exacerbating processes. [1]
Educational Benefits of Reading Case Reports
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Thus, in a three-page case report that can be read in less than 10 minutes, the reader learns key points on the differential diagnosis, etiology, epidemiology, diagnostic work-up, imaging findings, and management of pharyngeal obstruction from mononucleosis. Consider also a 2014 case report by Kreuels et al., “A case of severe Ebola virus infection complicated by gram-negative septicemia” [2]. This report meticulously describes the care of a patient with Ebola infection complicated by septicemia, respiratory failure, paralytic ileus, and encephalopathy, who was successfully treated with general intensive care measures. The patient put out 4–8 l of diarrhea per day over the first 72 h, and required 10 l
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