49-year-old HIV+ man presented with a mass lesion of the right mandibular gingiva. Imaging showed hypermetabolic soft tissue mass centered in the right retromolar trigone extending into the oral cavity. A minimally hypermetabolic focus in the right jugulo-digastric region was detected, likely representing a level 2 lymph node. In addition, subcentimeter, hypermetabolic bilateral inguinal lymph nodes were also reported. At the time of presentation, his labs showed CD4/CD8 ratio of 0.1 (absolute CD4 =170 cells/uL, absolute CD8 = 1567 cells/uL) and HIV viral load of 1061 copy/mL.