A 76‐year‐old man from rural Victoria presented with 4 months of difficulty swallowing due to a painful, large, non‐healing tongue ulcer (Box 1). He was diagnosed with Crohn's disease 20 years earlier, requiring previous small bowel resections and currently managed with azathioprine and infliximab. Associated symptoms included fatigue, fevers, night sweats and 5 kg weight loss. There was no relevant travel history or exposure to bird or bat guano.
Publication of your online response is subject to the Medical Journal of Australia's editorial discretion. You will be notified by email within five working days should your response be accepted.