Ecthyma gangrenosum (EG) is a rare, infective skin disease, predominantly but not exclusively caused by Pseudomonas aeruginosa . It is often seen in individuals with immunosuppression, although it has also been reported among previously healthy individuals. It was initially thought to be pathognomonic of P. aeruginosa septicemia, but this assertion was discarded following several reports on EG without bacteremia and EG with varied bacterial and fungal etiologies. There are scant reports of its association with human immunodeficiency virus (HIV) infection, while ocular involvement is extremely rare. An extensive search of the literature also found no report on EG, nor its relationship with HIV/acquired immunodeficiency syndrome (AIDS) from Sub-Saharan Africa. We hereby present a fatal case of multiple EG lesions in a 44-year-old Nigerian female with AIDS in the absence of bacteremia and review the literature of its association with HIV/AIDS and its concurrent orbital involvement.