Cutaneous Acanthamoeba infection is a rare complication of immunocompromised individuals including those having acquired immunodeficiency syndrome (AIDS), who often have concurrent central nervous system involvement. Acanthamoeba typically involves the skin and central nervous system by disseminating from a primary focus in the lungs or sinuses. We report an unusual patient with AIDS who developed cutaneous infection with Acanthamoeba, apparently without CNS infection but with sinus involvement. Histologically, the purpuric lesions showed prominent leukocytoclastic vasculitis as well as myriads of organisms.