Diffuse small intestinal inflammation is a rare finding which presents a diagnostic conundrum for most physicians. Its differential diagnosis includes conditions ranging from gastroenteritis to lymphoma. Ulcerative jejunitis (UJ) is a poorly understood disorder, which usually presents in the setting of celiac disease, and often is a harbinger of small bowel lymphoma. We present one of the few cases in medical literature of a patient, who developed UJ with a modest response to treatment with corticosteroids. The patient is a healthy 50-year old African American female who presented with a history of nausea, vomiting, and abdominal pain of one day's duration. The pain, described as tightness, was localized to the periumbilical and epigastric regions. The pain was quickly followed by vomiting and watery diarrhea. There was no obvious bleeding. These symptoms were followed by chills and low-grade fever. CT scan of the abdomen on admission revealed diffuse small bowel inflammation from the ligament of Treitz to the proximal ileum. Routine stool studies were negative. Anti-transglutaminase antibodies were negative. A push enteroscopy revealed severe ulceration and edema from the distal duodenum to the extent of the enteroscope. Biopsies revealed edema, abundant exudation, and some lymphocytic infiltration, compatible with chronic jejunitis. There were no granulomas, giant cells, vasculitis, or lymphoma. After a prolonged hospital stay marked by persistent symptoms, parenteral nutrition, a repeat enteroscopy, and a laparoscopic exploration, she was started on corticosteroids, which resulted in slow improvement but progressive improvement. UJ is a rare condition characterized by small bowel ulcerations, edema, abdominal pain, and malabsorption in the absence of any other etiology. Severe malabsorption leads to malnutrition and wasting. Malignant transformation into T-cell lymphoma is more common in the setting of celiac sprue. Early diagnosis, based on characteristic clinical, endoscopic, and histologic findings leads to early institution of corticosteroids. Corticosteroids are the mainstay of treatment, but are at best only moderately effective. Untreated, the prognosis is extremely poor, thus early recognition is imperative. Small bowel edema portends a difficult differential diagnosis to investigate. Ulcerative jejunitis may lead to malnutrtion and T cell lymphoma. Early recognition and treatment with corticosteroids is imperative to attempt to minimize risk of these complications.