A 38‐year‐old woman with longstanding Crohn’s disease presented with 7 months of a non‐healing widespread rash. Examination revealed indurated and ulcerated papulonodular lesions on the abdomen and extremities (Box 1). Medications included adalimumab, 6‐mercaptopurine, allopurinol and an oral contraceptive pill. There were no other significant medical conditions. The main differentials considered were cutaneous/metastatic Crohn’s disease or a disseminated atypical infection such as atypical mycobacterium or deep fungal. The lesions were too numerous for a skin malignancy.