The patient is a 36 year-old African American female with a 15 year history of Crohn’s disease complicated by severe perianal involvement not responsive to steroids or immunomodulating medication. The patient had undergone a proctocolectomy and diverting ileostomy two years ago secondary to refractory disease and had been symptom-free until 6 months prior to admission. At that time, the patient noted pain, vaginal discharge, and ulcerations in the perineal region. Three weeks prior to admission, she began to have almost daily vaginal bleeding as well as weakness, dizziness, and increased fatigue. She had no subjective fevers or chills and had no changes in output from the ileostomy. Outpatient medications included ciprofloxacin and metronidazole started 3 days ago by her gastroenterologist.