Coalescence of infection of the epiglottis, or epiglottic abscess, is a rare manifestation of epiglottitis. We report the case of a 49-year-old Hispanic man with HIV (CD4 count 243 [16.2%]), HIV viral load 175,689 copies per milliliter, antiretroviral-naive) contracted from his wife who presented to the emergency department with a 3-week history of sore throat, odynophagia, left temporal headache, left neck pain, and occasional blood-streaked sputum. This case represents the first reported case of epiglottic abscess in an HIV-positive individual. Epiglottic abscess formation is associated with potentially rapid airway compromise and carries a high mortality rate. The diagnosis of epiglottic abscess is often difficult. In HIV-infected individuals, a variety of infectious and oncologic sources of respiratory compromise should be considered in addition to epiglottic abscesses. Prompt diagnosis and treatment of this condition is crucial for ensuring optimal outcomes in this rare but often lethal infection.