A 19-year-old man with a 1-year history of Crohn's disease of the ileum and rectosigmoid developed back and leg pain with neurological deficits. He proved to have an epidural and subdural spinal empyema originating from a rectal fistula. Drainage of the empyema, a diverting sigmoid colostomy, and appropriate antibiotics allowed full recovery of neurologic function and resolution of infection. We review the applicable literature.