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Published on: May 1, 2015
Perforated peptic ulcer disease as the initial presentation of previously unknown multiple myeloma and sickle cell
Matthew Ross Gowell1, Ahrin Anna Morrow2
1General Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK matthew.gowell@live.co.uk.
Abstract:
Peptic ulcer disease (PUD) is a common cause of abdominal pain which can present acutely with gastrointestinal perforation. This report presents an exceptionally rare case of a patient whose presentation of perforated PUD heralded a new diagnosis of both multiple myeloma and sickle cell disease (SCD). Histological analysis of the ulcer tissue, following omental patch repair, did not demonstrate features of extramedullary myeloma or amyloid light chain deposition, two pathologies traditionally thought to drive PUD in this patient group. Instead, we suggest malignant hypercalcaemia stimulating gastric acid secretion, in combination with mucosal ischaemia caused by SCD, may have led to gastric mucosal erosion. This case underscores the diagnostic challenges in managing patients with complex comorbidities and the need to consider atypical causes of PUD in the workup of this patient group.
Insights
A rare case of perforated peptic ulcer disease (PUD) led to new diagnoses of multiple myeloma and sickle cell disease (SCD). This highlights atypical PUD causes in complex patients.
Area of Science:
- Gastroenterology
- Hematology
- Internal Medicine
Background:
- Peptic ulcer disease (PUD) commonly causes abdominal pain and can present as gastrointestinal perforation.
- Patients with complex comorbidities pose diagnostic challenges, especially when PUD is the initial presentation.
- Multiple myeloma and sickle cell disease (SCD) are rare co-diagnoses presenting with perforated PUD.
Purpose of the Study:
- To report an exceptionally rare case of perforated peptic ulcer disease (PUD).
- To highlight the co-occurrence of PUD with newly diagnosed multiple myeloma and sickle cell disease (SCD).
- To discuss potential atypical pathophysiological mechanisms for PUD in patients with multiple myeloma and SCD.
Main Methods:
- Case report detailing a patient's presentation, diagnostic workup, and treatment.
- Histological analysis of ulcer tissue following surgical repair (omental patch).
- Review of literature concerning PUD in the context of multiple myeloma and SCD.
Main Results:
- Perforated peptic ulcer disease (PUD) was the initial presentation leading to diagnoses of multiple myeloma and sickle cell disease (SCD).
- Histology of the ulcer tissue did not reveal extramedullary myeloma or amyloid light chain deposition.
- A proposed mechanism involves malignant hypercalcemia-induced gastric acid hypersecretion and SCD-related mucosal ischemia.
Conclusions:
- This case underscores the diagnostic complexity in patients with multiple comorbidities.
- Atypical causes of peptic ulcer disease (PUD) should be considered in patients with multiple myeloma and sickle cell disease (SCD).
- Malignant hypercalcemia and sickle cell disease-related ischemia are potential contributors to PUD in this unique patient cohort.
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