A symptom jigsaw

Diagnosis is like a jigsaw puzzle, where all the pieces have to fit perfectly to picture the whole. A recent patient reflected this concept: she had a plethora of symptoms and nobody had been able to put a finger on the underlying problem. She had had many medical tests which were essentially normal but she was still feeling unwell.

The pieces

She was in her early 30s with a high-powered job and a social life to match, although she was finding that her tolerance for alcohol was dropping and