Peptic ulcer disease: an unusual presentation of a common problem.

Question: A 40-year-old man presented to the emergency department with a 3-day history of hematemesis and melena on a background of 6 months of intermittent, epigastric pain. He was a current smoker with a 7 pack-year history and denied aspirin, non-steroidal anti-inflammatory drugs (NSAIDs) or alcohol use. His medical history was otherwise unremarkable.