Solitary rectal ulcer syndrome (SRUS) is an uncommon condition that presents with non-specific symptoms shared by other disease processes. This case report shares a unique presentation in which a patient was thought to have fistulous perianal Crohn's disease then underwent treatment with infliximab but was ultimately found to have SRUS. The prognosis and treatment of SRUS vary greatly from inflammatory bowel disease. Making the correct diagnosis is imperative when considering Crohn's disease and its mimickers.