A 43-year old male accountant, married for 15 years and living in England, had complained of general malaise and weight loss for 18 months. For the last year he had had increasingly severe chronic ulceration and excoriation in the anal area, needing to wear sanitary pads.
He was managed mainly by colorectal surgeons who were searching for bowel cancer. Sigmoidoscopy, colonoscopy and barium enema had been very painful, but showed no sign of disease.
He became progressively weaker and his haemoglobin fell to 7.9g/dl.