The initial evaluation of reported inflammatory bowel disease (IBD) should include an assessment for immunosuppression which can broaden the differential diagnosis to include opportunistic infection as well as other processes. Here we present an exceedingly rare case of a patient with a self-reported history of Crohn's disease presenting with frequent diarrhea presumed to be a Crohn's flare, however, after further workup was found to have extensive visceral Kaposi sarcoma (KS).