The case report is not dead

Abstract

We write to congratulate Rosemary Mason on her excellent Editorial on the decline of the case report (Mason. Anaesthesia 2001; 56: 99–103) and to provide support for her argument that the case report ‘occupies a more central role in the continuing education of anaesthetists’. The same issue of Anaesthesia contained an article presenting two case histories of wound botulism in UK drug addicts (Mulleague et al. Anaesthesia 2001; 56: 120–4). Both articles were read by one of the authors (J.D.) before the start of a routine general anaesthetic MRI list. Following the routine cases, an emergency was added to the list. On being told the patient was a 50-year-old heroin user who was transferred to our hospital with profound muscle weakness resulting in a respiratory arrest, with a presumed diagnosis of Miller fisher variant of Guillain–Barré syndrome, the anaesthetist in question immediately supplied the diagnosis of botulism on the strength of the two case reports. The reference laboratory has subsequently confirmed this diagnosis. The patient has been treated with benzyl penicillin, botulinum antitoxin and a previously unnoticed buttock abscess drained. There has been a clinical improvement as a result of the prompt diagnosis. The consultant has been awarded a gold star for clinical acumen. In view of this we would reiterate the value of the case report as a diagnostic and teaching tool, and hope it will continue in its current form in Anaesthesia and all other anaesthetic journals of repute.