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.
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