Background: Crohn’s disease, a chronic inflammatory bowel disease (IBD) that was once considered rare in the pediatric population, is currently recognized as one of the most important chronic diseases that affects children and adolescents. Extra-intestinal manifestations rarely can precede IBD leading to a late diagnosis. Case Report: This is a case report of a 13 year old boy admitted for draining abdominal fistulae. The patient refers a six year history of musculoskeletal manifestations with low back pain, recurrent fever and limping. Six months ago he underwent surgery for pelvic abscesses. After surgery he was referred to our service for draining an abdominal fistula. We performed a colonoscopy which shows images and histology compatible with Crohn’s disease. We decided to treat the patient with infliximab, 5 mg per kilogram of body weight administered intravenously at weeks 0, 2, and 6. After the second dose of infliximab we noticed the complete closure of the fistula. Conclusion: Infliximab is a good treatment alternative in patients with Crohn’s disease preceded by musculoskeletal manifestations and complicated by abdominal fistula.