Your case should illustrate at least one of the following. State which one, in your Background.

• Management of a novel or very uncommon disease
• A common disease presenting in an uncommon way
• An uncommon disease masquerading as something more common
• A case that expands understanding of disease pathogenesis
• A case where the teaching point rests on an error
• A case that prompts us to re-think established medical lore
• An unreported adverse effect of an intervention — drug, procedural or other

Title (20 words) — Describe the clinical problem, not the final diagnosis. A title that gives away the answer removes the diagnostic interest.

Background (50 words) — The clinical context, why this case matters, and which of the categories above it illustrates.

Case details (180 words) — In sequence: presenting complaint with duration, relevant history and examination findings with actual values, investigations with actual results, the differential considered, what was done, and the patient’s progress and outcome. Give real numbers — eosinophil counts, IgE levels, spirometry values, drug doses, timings. De-identify completely: no names, no hospital numbers, no admission dates, no images containing identifiers.

Discussion (80 words) — Why the decisions were made, what made this case difficult, and how it fits with what is known.

Conclusion (40 words) — The transferable lesson, ending with one sentence stating explicitly what a clinician should do differently having read this.

Additional rules for cases

• A partially worked-up case may be submitted. If the diagnosis is unresolved or management is still uncertain, say so plainly and state the specific question you want the panel to address. These cases are welcome and are judged on the quality of the reasoning, not on having reached an answer.
• One image maximum, JPEG or PNG, under 500 kb. Clinical photographs must not show identifiable features unless you hold written patient consent, which must be declared on the form.
• Patient consent for presentation must be confirmed on the form.

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SAMPLE ABSTRACT — MEDICALLY CHALLENGING CASE

This case is entirely fictitious and is provided only to illustrate structure and depth. Do not cite or reuse any of it.

Category: Medically challenging case (adult)

Title: Recurrent perioperative hypotension attributed to anaesthesia in a patient with mastocytosis (12 words)

Authors: G. H. Priya (presenting), I. J. Varghese Affiliation: Department of Pulmonary Medicine, Sample Medical College, Vellore, Tamil Nadu, India

Background Perioperative anaphylaxis is frequently attributed to neuromuscular blocking agents, and re-exposure is avoided without formal evaluation. This case illustrates a common disease presenting in an uncommon way, and the diagnostic cost of accepting an unevaluated label. (37 words)

Case details A 42-year-old man was referred after three episodes of profound hypotension during general anaesthesia over six years, each occurring within ten minutes of induction and each attributed to atracurium, which was subsequently avoided. He reported intermittent flushing and unexplained syncope for eight years, and episodic abdominal cramps. Examination showed scattered reddish-brown macules over the trunk with a positive Darier sign. Baseline serum tryptase was persistently elevated at 34.8 ng/mL and 31.2 ng/mL twelve weeks apart. Skin testing to atracurium, rocuronium, succinylcholine, latex and chlorhexidine was negative. Bone marrow biopsy showed multifocal dense aggregates of spindled mast cells co-expressing CD25, with a KIT D816V mutation. Systemic mastocytosis was diagnosed. He underwent elective hernia repair under a mastocytosis-specific protocol with premedication, without incident. (122 words)

Discussion Three anaesthetic agents were avoided over six years on the basis of a label that formal evaluation did not support, while the underlying disorder went undiagnosed. Recurrent perioperative collapse with cutaneous findings and persistently raised baseline tryptase points to a clonal mast cell disorder rather than drug hypersensitivity. Sequential drug avoidance without evaluation progressively narrows anaesthetic options while leaving the true risk unaddressed. (63 words)

Conclusion Baseline tryptase — not only acute tryptase — should be measured in every patient referred after perioperative anaphylaxis, and formal drug allergy evaluation should precede permanent labelling of any agent. (30 words)

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Common reasons abstracts are marked down

Read this list against your own draft before you submit.

• Results reported without numbers, denominators, or measures of precision
• No explicit aim; the reader cannot tell what question was asked
• Study design not named, so the reader cannot judge the strength of the inference
• Conclusions that go beyond what the data show
• A case report submitted in research format, or vice versa
• The title gives away the diagnosis in a case, or is a vague phrase in research
• Undefined abbreviations, or abbreviations in the title
• Author order wrong, or presenting author not entered first
• Ethics approval or patient consent not confirmed
• Sections padded to reach the word limit — the limits are ceilings, not targets