Chest Pain and Papules in a 37-Year-Old

Rajdeep Chana, DO; Saurabh Sharma, MD


August 30, 2023

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.


A 37-year-old man presents to the emergency department with substernal chest pain. The pain started earlier in the day as he was climbing a flight of stairs, and it was alleviated with rest. Later, the chest pain occurred even at rest, which prompted him to seek medical attention. He reports no recent shortness of breath, leg swelling, abdominal pain, nausea, vomiting, or diarrhea.

The patient does not smoke, drink alcohol, or use illicit drugs. His medical history is significant for type 2 diabetes mellitus, hypertension, and past episodes of pancreatitis. He has no history of gallstones or cholecystitis. For the past year, he has noticed painless, nonpruritic "bumps" on his elbows. He reports no joint pain. His family history is significant for a myocardial infarction in his grandfather when he was in his mid-30s. The patient's medications include metformin, insulin, atorvastatin, and amlodipine.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.