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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.<\/jats:p>","DOI":"10.1136\/bcr-2024-261990","type":"journal-article","created":{"date-parts":[[2025,2,17]],"date-time":"2025-02-17T17:45:56Z","timestamp":1739814356000},"page":"e261990","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Perforated peptic ulcer disease as the initial presentation of previously unknown multiple myeloma and sickle cell anaemia"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0674-0697","authenticated-orcid":false,"given":"Matthew Ross","family":"Gowell","sequence":"first","affiliation":[{"name":"General Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahrin 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