Capturing zebras: what to do with a reportable case.

We had attempted to publish a report of an unusual manifestation of an uncommon disease discovered at autopsy. The case report was not accepted for publication because we had failed to order a highly specific test that would have unequivocally confirmed the diagnosis we entertained and subsequently wrote about. After much deliberation about this case and an extensive review of the literature, we now believe that there is a preferred approach to dealing with a reportable case. Because physicians seldom encounter cases that are reportable, we felt that sharing the important lessons we learned from our missed opportunity might prove helpful and encourage those who are considering preparing a case report for publication.