ABSTRACT
A 25-year-old man presented to the emergency department complaining of a 10-day history of worsening central chest pain. The pain was sharp in nature and had come on gradually, with no obvious precipitant, and was worse on deep inspiration. Ibuprofen and aspirin had slightly relieved the pain. The patient felt otherwise well and denied recent illness or trauma. He had no symptoms of cough or shortness of breath. His past medical history included two hospital admissions as a child, where he had been diagnosed with presumed pyelonephritis. Aside from the recent use of non-steroidal anti-inflammatory drugs, he took no regular medications. He was a university student, smoking around five cigarettes each day and drinking 10–12 units of alcohol weekly. He was born in the United Kingdom and his family were of Cypriot origin. He had last travelled abroad 3 years earlier, visiting Honduras and Nicaragua.
