A 52-year-old man presents to a private dermatology clinic with a history of severe recalcitrant hidradenitis suppurativa (HS) and concomitant rheumatoid arthritis. The patient is an active duty master sergeant in the U.S. Army and has just relocated for a permanent change of station to active drilling reservist status. He is motivated to continue managing his HS with infliximab, and he wishes to explore insurance coverage. Although not indicated for treating HS, infliximab may be a viable option for severe recalcitrant HS. The following case study presents the history, assessment and plan, treatment, evaluation, and discussion highlighting important points regarding the use of a biological agent in severe recalcitrant HS and concomitant rheumatoid arthritis.