A 36-year-old man presented to an emergency room with fever, fatigue, and severe rectal pain. He was subsequently found to be pancytopenic with a perirectal abscess. A bone marrow examination revealed 58% blasts consistent with acute myeloid leukemia. The patient was initiated on clofarabine, idarubicin, and cytarabine therapy. The first cycle of therapy was complicated by neutropenic fever, bacteremia, and pneumonia. The second cycle was complicated by delayed platelet recovery. As a result, the patient was referred for possible stem cell transplantation.