A Fishy Tale of Macrocytosis

Abstract

A 43-year-old woman presented to her family physician with a two-year history of fatigue, diarrhea, and constant dull abdominal discomfort. Stools were described as normal in frequency and intermittently loose in consistency. In addition, she also experienced two to three episodes per month of non-bloody painless diarrhea, which was associated with a cramping abdominal pain. She attributed this pain, which radiated to the back and pelvis, to her menstrual cycle. During this period, she did not have any nausea or vomiting and did not notice any change in weight or appetite.