A 44-yr-old homosexual male with symptomatic human immune deficiency virus (HIV) infection presented with abdominal pain, hepatosplenomegaly, and rising serum alkaline phosphatase. Laparoscopy revealed multiple purplish nodules on the surface of the liver. Histopathology of the lesions was consistent with Kaposi's sarcoma. Six weeks later, cutaneous Kaposi's sarcoma became apparent on the head and neck. This case is unusual because, in all previously published cases, with the exception of one, intrahepatic Kaposi's sarcoma was found on autopsy. Moreover, all patients had evidence of extrahepatic Kaposi's sarcoma prior to the documentation of liver involvement.