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A 50-year-old woman was referred to gastroenterology with a 3-month history of diarrhoea containing mucus and blood, abdominal pain, weight loss, mouth ulcers, palpable lymphadenopathy and night sweats. She reported no fevers and stool testing excluded enteric infections. Faecal immunochemical test was positive and faecal calprotectin measured 138 µg/g. CT showed abnormal thickening of the rectum and mid/distal sigmoid with enlarged abdominal lymph nodes. Endoscopy revealed moderate inflammation and ulceration in the terminal ileum and rectum most consistent with Crohn’s. Biopsies identified the lamina propria as being infiltrated with polyclonal T and B lymphocytes, with areas of cryptitis and a possible granuloma. The samples sent to Haemato Oncology Diagnostic System were consistent with chronic active Epstein-Barr virus (CAEBV) with no evidence of lymphoma. Further biopsies, obtained from a groin lymph node, showed histiocytic proliferation and expansion, no features of CAEBV and no evidence of lymphoma. EBV serology testing was immunoglobulin G positive but immunoglobulin M negative, suggesting past infection. The patient was prescribed prednisolone for suspected inflammatory bowel disease (IBD). After 6 weeks, her symptoms continued to worsen. Hence, repeat early endoscopy was arranged ( figures 1 and 2). Repeat CT showed worsening of the lymphadenopathy.