Rheuminations: The Humble Case Report Tells a Story

I often think about medical literature as a sprawling metropolis. There are towering skyscrapers of randomized controlled trials, lofty schools of systematic reviews and meta-analyses, and verdant parks of qualitative studies. Much less assuming are the case reports, which are sort of like homesteads for the majority of people who publish and contribute to the vitality of medical literature. They are often overlooked or dismissed as anecdotal, but the truth is that case reports remain a crucial part of how we learn, adapt and advance our field, especially in rheumatology.

Although they lack the statistical power of large studies, case reports hold a different kind of, almost imaginative, power: They capture the nuances of disease, document the rare and unexpected, and remind us of the complexity of individual patient experiences. They are often the first whispers of new syndromes, unrecognized drug reactions or paradigm-shifting treatment responses. They also serve as an entry point into academic writing for trainees and early career physicians, offering a unique opportunity to sharpen clinical reasoning and storytelling skills.

So why do case reports matter, and how can aspiring authors craft a case report that is both meaningful and novel. Let’s rheuminate!

Why Case Reports Matter

At its heart, rheumatology remains a specialty that emphasizes pattern recognition. Clinicians must connect seemingly disparate symptoms, signs and results into a coherent diagnosis. Given the heterogeneity of the autoimmune and inflammatory diseases that we encounter, no two patients present exactly alike, and many diagnoses hinge on recognizing subtleties that deviate from textbook descriptions.

This is where case reports are so vital. They document clinical scenarios that expand our understanding of disease phenotypes, challenging us to refine our diagnostic frameworks. For example, case reports continue to expand our characterization of immune-related adverse events (IRAEs) associated with checkpoint inhibitors, which in turn leads us to have a deeper appreciation of T cell immunology.¹ Similarly, Graham Hughes and colleagues’ case reports in the 1980s of young patients experiencing recurrent thrombosis, pregnancy losses and neurological symptoms later led to the recognition of antiphospholipid antibody syndrome.² Of course, these reports do not offer definitive conclusions, but they do provide the first signals that drive deeper investigation.

Beyond novelty, case reports also serve as practical teaching tools. Many of us learned rheumatology through the study of individual cases, whether presented in morning report, shared during grand rounds or immortalized in journal articles. A well-written case report doesn’t just say, “Look at how cool this rare disease is,” it invites readers into the clinical, decision-making process, illuminating key diagnostic dilemmas and therapeutic considerations.