Elizabethkingia miricola (E. miricola) is a gram-negative rod initially isolated from condensation at the Russian Mir space station. In the literature, there are few cases of human isolates that have been identified, with only one prior case of E. miricola urinary tract infection (UTI). Here we report a case of a patient with a chronic suprapubic catheter that was found to have E. miricola UTI with fistulization between the bladder and pubic symphysis, leading to osteomyelitis and surrounding pyomyositis. He was placed on Tigecycline based on susceptibility profile, underwent bilateral nephrostomy tube placement and discharged home with close outpatient follow-up. With the increasing use of novel detection methods, accurate identification and antimicrobial susceptibility testing is necessary for this multidrug resistant organism and others like it.