54-year-old man with weight gain and muscle weakness

• Medical history: Ulcerative colitis for 30 years, controlled on medications, primary biliary cirrhosis, depression, type 2 diabetes (recent diagnosis). No history of hypertension or cardiac disease.


• Surgical history: Pyloric stenosis surgically repaired as a neonate.


• Medications: Citalopram 20 mg once a day, mesalazine 1 g twice a day, ranitidine 150 mg twice a day, ursodeoxycholic acid 500 mg twice a day, metformin 500 mg three times a day.


• Allergies: Previous tongue swelling after lymecycline.


• Family history: Not known (adopted).


• Social history: Patient works as a community psychiatric nurse, is married but recently separated due to his mood swings. He is a nonsmoker, has no alcohol intake, no recreational drugs use. No recent travel abroad.