For 3 months, a 50-year-old man had been bothered by a worsening and spreading rash on his feet and lower legs. The multiple, nodular, fungating lesions were nonpruritic. The heterosexual, unmarried patient did not use intravenous drugs and did not know his HIV status; he denied any significant medical history. Histologic examination of a biopsy specimen from a leg lesion revealed Kaposi sarcoma. The results of an enzyme- linked immunosorbent assay were confirmed by Western blot technique, which indicated the patient was seropositive for HIV. His CD4+ cell count was 19/μL. Dr Umar Hardi of New York writes that Kaposi sarcoma is a rare initial presentation of HIV infection; the cutaneous condition typically is seen in severely immunosuppressed patients with CD4+ counts lower than 50/μL. Lesions can occur on the legs, as in this patient, or in the mouth, lungs, or GI tract. The patient was given highly active antiretroviral therapy (HAART) as well as doxorubicin hydrochloride liposome injection. His CD4+ cell count has increased; the Kaposi sarcoma lesions have ameliorated.