The Manchester United midfielder Darren Fletcher looks set to miss the rest of the season at the very least as he battles the chronic bowel condition ulcerative colitis which could prove career-threatening – the latest blow to befall Sir Alex Ferguson's side in the space of a week.
The club captain, Nemanja Vidic, ruptured three ligaments in the defeat to Basle last week and could miss up to a year, although it is Fletcher's condition that appears the more serious. The club finally disclosed the mystery illness that caused the Scottish midfielder to miss the best part of two months last season and has limited the 27-year-old's appearances this season.
Announcing that Fletcher would be taking a break from playing, the club conceded that his "continued desire to play and his loyalty to both his club and country has probably compromised the chances of optimising his own health and fitness".
The condition can cause diarrhoea, bowel inflammation, stomach pain and, in the worst cases, the sufferer can lose control of their bowel movements. It can be made more serious by stress and United's reference to Fletcher's attempts to play again having "compromised" him could allude to the medication that can be used to treat the condition.
Former England rugby captain Lewis Moody, who also suffers from ulcerative colitis, has a "therapeutic use exemption" granted under the rules of the World Anti-Doping Agency for his medication. The Bath player has admitted that on "bad days" he needs as many as eight tablets to control his condition.
United said they had been reluctant to make public Fletcher's condition "in order to respect his right to medical confidentiality" and that he had been suffering from ulcerative colitis before this year, when his absences became noticeable.
After appearing as a substitute against Liverpool on 6 March he played just twice more last season, unusual for a player who has been a regular at United since 2003. He missed the club's pre-season tour to the United States in the summer and his appearances for United and Scotland have been intermittent since then. His condition was previously given by the club as a "viral illness", although he admitted in September to having lost a stone in weight.
Despite knowing about the severity of his condition, the club still agreed a new four-year contract with the player in March, which suggests that they have confidence in him making a return at some point.
The United statement continued: "Whilst he [Fletcher] was able to maintain remission of symptoms for a considerable period this has proved more difficult recently and Darren's continued desire to play and his loyalty to both his club and country has probably compromised the chances of optimising his own health and fitness."
It leaves Ferguson with even fewer options in central midfield. He now only has Michael Carrick, Anderson and Ryan Giggs to choose from in that position, with Tom Cleverley injured. Darron Gibson and Paul Pogba remain on the fringes.
The Internazionale midfielder Wesley Sneijder has long been identified as a possible addition. A more like-for-like replacement for Fletcher is Javi Martinez, the Athletic Bilbao player, or Nicolas Gaitan, the Argentine who impressed for Benfica against United in the Champions League.