Case Presentation: A 69-year-old male with a complex medical history including coronary artery disease, abdominal aortic aneurysm, and polyarthralgia was hospitalized for treatment of lower extremity necrotizing fasciitis and refractory ulcers. During hospitalization, the patient developed intermittent melena. Upper endoscopy was unremarkable. Contrast-enhanced CT revealed biliary dilation with evidence of blood in the biliary system [...]