A 71-Year-Old Man With Unremitting Epigastric Pain

Stephen Suah, MD, MS; Padma Chitnavis, MD; Mary Maiberger, MD

Disclosures

August 14, 2017

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.

Background

A 71-year-old man presents to the emergency department with severe pain in the epigastrium. The pain started 1 day ago, reportedly after he ate a large fatty meal for lunch. The patient reports two similar episodes in the remote past after eating fatty meals, which resolved with over-the-counter antacid therapy. However, the current pain has been resistant to multiple doses of over-the-counter antacids. Positional changes do not affect the pain.

The patient denies having pain that is radiating to his shoulder, down his arm, or to his jaw or back. Because the pain was unremitting, he presented to the emergency department. He denies fevers, chills, change in urine or stool color, nausea, vomiting, or diarrhea.

The patient's medical history includes multiple myeloma, hypertension, and dyslipidemia. One year ago, he underwent allogeneic bone marrow transplant for multiple myeloma. He states that the transplant was successful and that he is closely monitored by his hematologist/oncologist. Currently, his medications include cyclosporine, prednisone, and lisinopril.

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