Purpose: Background: Morgellon's disease is a poorly described, severe ulcerative skin condition that histologically is consistent with dermatitis artefacta. It has therefore been dismissed as a psychosomatic disorder, much as was the case with ulcerative colitis in the period from 1930 to 1960. We present the first case of a patient with Morgellon's syndrome who had additional findings suggesting that it is a systemic disease. Case Report: A 65 year old white female presents to us with an unexplained iron deficiency anemia. She had a history of systemic lupus and a 2 year history of severe skin ulcerations. The ulcers contained fragments of black material. She had been seen by multiple specialists who told her that the lesions were self-inflicted and that she should get psychiatric care. Physical exam was of note for numerous papules with erythematous, ulcerated centers measuring 2 to 12 mm located on the trunk, back, upper and lower limbs and outer ear canal. The ulcers were notable for sharply angulated corners and clearly demarcated edges. She had extensive scarring on her arms and legs. Her labs were notable for a hemoglobin of 9.1 g/dL with MCV 83.3, serum albumin 3.4, and ESR 32. ANA was negative. She had recently completed a course of intravenous iron. A video capsule was performed. This showed denuded villous patches in the jejunem, which were unusual for their sharply angulated appearance, similar to her skin lesions. Small bowel biopsies were normal. Skin biopsy showed hemorrhage and non-specific inflammation. Histology of the black debris from her ulcers suggested vegetable matter. Repeat capsule examination 6 months later showed spontaneous resolution of the denuded patches. Occlusion treatment on one limb led to some improvement. Discussion: This patient demonstrated cutaneous ulceration consistent with Morgellon's syndrome, but she had co-existing evidence for systemic disease with iron deficiency, low albumin and small bowel villous changes consistent with a mild enteritis. This is the first time that evidence for systemic disease has been demonstrated in association with what has previously been considered a disorder limited to the skin. Further investigations are warranted in a larger patient population.