A 41 year old shop assistant was admitted with a seven week history of colicky lower abdominal pain associated with alternating constipation and diarrhoea. In the preceding three weeks, she had experienced night sweats and had lost 5 kg in weight. The patient was not taking any regular medication apart from steroid inhalers for mild asthma. Her periods were regular with no abnormal vaginal bleeding. She had recently developed a creamy white vaginal discharge, which had not been evaluated. The last menstrual period was three weeks before admission but a recent pregnancy test was negative. The obstetric history was gravida 5, para 3. An intrauterine contraceptive device (IUCD) had been inserted five years before.

Examination revealed a thin, emaciated women distressed by pain. She was afebrile and the vital signs were within normal limits. Mild suprapubic tenderness was noted on palpation. No organomegaly was discernable. Vaginal and rectal examination were normal. The laboratory findings . . . [Full text of this article]