Perianal Pain Associated With Crohn Colitis: What Next?

What would your diagnosis be in this young man and how would that inform your next step?

A 28-year-old man with Crohn colitis on maintenance therapy with infliximab 5 mg/kg every 8 weeks presents with perianal pain. On examination, he has a 1-cm tender lesion with fluctuance near the anus. 

Which of the following should be the next step in management?

A. Increase inflixamab to 10 mg/kg
B. Initiate IV antibiotics
C. Refer for incision and drainage
D. Perform exam under anesthesia in conjunction with MRI of pelvis
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