The peer-reviewed articles don’t state anywhere the cases described are fictional.

I was going to speculate that these fraudulent "Case Reports" may not have been peer-reviewed at all (Case Reports in medical journals are simply interesting anecdotes of an IRL case that a clinician writes up & publishes about a rare presentation or a disastrous result. They are very different than primary literature about actual observational or RCT studies).

But I stand corrected in the very 1st paragraph of reading the link, as you are correct that the fake submissions passed peer review.

The surveillance highlights “are intended for paediatric health care providers or physicians in training, and include learning points that briefly translate and disseminate knowledge about the disease or condition,” Elizabeth Moreau, a spokesperson for the Canadian Paediatric Society, told us by email. 

The journal decided when it first started publishing the article type “that the cases should be fictional to protect patient confidentiality,” Robinson told us. “Apart from the case that led to the recent New Yorker article, all or almost all were cases of very well recognized conditions (such as congenital syphilis, fetal alcohol syndrome, serious trauma from ATVs, hepatitis C infection) where a single case report would not generate any interest or ever be cited.”

Pretty wild that the editors now claim decades later that they purposely knew the hundreds of fraudulent case reports were published without a disclaimer for "teaching purposes".

Some of the commenters on the article note that this is likely facesaving lies, as TWBM archives show that the actual "fictional case" disclaimer was only added after Sept 2025.