Severe Isolated Chest Pain as the Sole Manifestation of Duodenal Ulcer: A Case Report with 19-Month Follow-up

Abstract Background Chest pain is a common clinical presentation with a wide range of differential diagnoses. Visceral disorders can mimic chest pain through the mechanism of visceral-cutaneous referred pain; this is particularly likely to lead to misdiagnosis across medical specialties when typical gastrointestinal symptoms are absent. Case presentation A 24-year-old male patient presented with isolated right-sided chest pain that had persisted for over one month and had worsened over the past 20 days (NRS score of 8/10), with no gastrointestinal symptoms. He had previously been evaluated by the departments of thoracic surgery, dermatology, and pain medicine; chest CT, thoracic spine MRI, and CTA of the lungs and thoracic aorta were all negative. The pain medicine department led a multidisciplinary evaluation, which included abdominal CT and gastroscopy.Gastroscopy revealed a deep, large ulcer in the duodenal bulb (Stage A1), and Helicobacter pylori was detected. Two days after initiating treatment for the ulcer and to eradicate Helicobacter pylori, the pain subsided significantly, and tramadol was discontinued. The patient was discharged on the fifth day after showing improvement. At the 19-month follow-up, the patient remained pain-free. Conclusion This case demonstrates how visceral pain can "cross-system" and manifest as somatic chest pain. The 19-month period of complete remission strongly supports the diagnosis that duodenal ulcer is the cause of the patient's chest pain. Clinicians should recognize that the anatomical location of symptoms does not necessarily indicate the site of the lesion. Long-term follow-up is a crucial step in verifying the diagnostic hypotheses of difficult cases.