Chest pain during triple therapy for duodenal ulcer.

摘要

A 23-year-old previously healthy man presented to the emergency service with the sudden onset of sharp chest pain after 4 h of continuous hiccup. The pain was poorly localized, but aggravated by inspiration. He was a non-smoker and denied recreational drug use. A diagnosis of grade I gastroesophageal reflex disease and duodenal ulcer secondary to Belicobacter pylori had been made by upper gastrointestinal pan-endoscopy 10 days earlier and eradication therapy with clarithromycin 500 mg b.i.d., ome-prazole 20 mg b.i.d. and metronidazole 500 mg b.i.d. was prescribed. He developed dyspepsia, nausea and intractable hiccup on the fifth day of treatment. On physical examination, he appeared agitated with blood pressure of 118/68, pulse rate of 110 b.p.m., body temperature of 36.8 deg C and a respiratory rate of 22/min. Palpation of the chest wall did not elicit any discomfort and there was no s.c. emphysema. The chest was clear to auscultation and the heart sounds were normal.