A patient injury by chiropractic manipulation. Two case reports. Two editor’s notes. – Retraction watch


What happens when two different groups from two different medical specialties see a patient and then write separate case reports?

Ask the teams of doctors from the departments of neurology and rheumatology at the Faculdade de Medicina, Universidade de São Paulo in Brazil. They both published case reports of a patient injured after undergoing chiropractic manipulation of the spinal cord. And now both journals have editor’s notes acknowledging the double publication.

The patient’s case appeared in Neurology as “Spinal Cord Injury, Vertebral Artery Dissection, and Cerebellar Strokes After Chiropractic Manipulation” and as “Breaking Diagnosis: Ankylosing Spondylitis Evidenced by Cervical Fracture Following Spine Manipulation” in the journal Internal and emergency medicine. Both publications included the same figure and reported many of the same details about the undiagnosed ankylosing spondylitis patient who suffered spinal cord injury and strokes after undergoing spinal cord manipulation.

The editors of both journals published notes noting the cases, an expression of concern in Internal and emergency medicine and a “duplicate publication notice” in Neurology.

The reviews are almost identical and state, in part:

Both case reports were written by authors from the Faculdade de Medicina, Universidade de São Paulo. The authors of the article published in Internal and emergency medicine were affiliated with the Department of Rheumatology, and the authors of the Neurology article were affiliated with the Department of Neurology.

The authors of both articles were contacted and asked for an explanation for the double publication. Both teams of authors explained that they cared for the patient when he was admitted to the hospital and that they were unaware of the other team’s submission.

Although the patient is the same, as was much of the discussion, the two articles are not, the journal’s editors explained:

The focus of the articles is different: one focuses on bone injuries and emergency care, and the other on the neurological aspects of the case. Both groups of authors apologize for duplicate submissions and agree with this statement.

The duplicate post was revealed after two chiropractors wrote to Neurology noting the similarities between the two cases and expressing concern that the patient in question did not receive care from a properly trained chiropractor.

In an email to Retraction Watch, Neurology Journals Editor-in-Chief Patricia Baskin said:

We believe we have detailed all the information in this situation of double publication by two groups of authors in which each group was unaware that the other group was also writing a report on the same patient. We encountered a similar situation in our log in 2013, when we published a similar notification.

When someone reports a duplicate posting to us, we check with the authors and institutional authorities to determine the circumstances surrounding the duplicate posting. In both of these cases, we determined that the duplication was unintentional.

Marina Barguil Macêdo, who was the corresponding author of the article in Internal and emergency medicine and is now at the University of Washington, shared the statement she and her colleagues wrote in response to the investigation into a possible duplicate post:

We in the Division of Rheumatology were completely unaware that the Division of Neurology had submitted a manuscript on the same case to another journal. Our hospital is the largest public university hospital in Latin America, so a patient is usually cared for by different teams who, despite collaborating on case management, hold their scientific discussions separately. We really regret this double posting, but we can’t stress enough that it was in no way intentional.

As Baskin’s note indicates, duplicate postings of the same patient case by two different groups of physicians occasionally occur, and we have reported a few of them.

In 2012, two different research groups at Myongji Hospital in Goyang, Korea submitted case studies of the same patient to different journals, first to the Journal of the Korean Society of Plastic and Reconstructive Surgeons and next to Annals of Dermatology.

Unlike the recent case of Brazil, Annals of Dermatology the publishers retracted their publication, as detailed in the retraction notice:

Like some of the case report images in the Annals of Dermatology have been used without the permission of the original publisher, this is a duplicate publication. Thus, the editorial board of the Annals of Dermatology ultimately decided to retract it in its entirety.

Two different groups at a Turkish hospital wrote in 2015 about the same 75-year-old woman who developed internal bleeding after taking a blood thinner. The first case report appeared in the Indian Journal of Pharmacologyto be detailed again in the Journal of Clinical and Therapeutic Pharmacy. As with the Korean case, the editors of the second publication eventually retracted it.

And in 2020, two groups of doctors from different Iranian hospitals described what they claimed was the first death of a pregnant woman from Covid-19. The second article about the patient, in Travel Medicine and Infectious Diseaseswas retired in May 2020.

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