Ecthyma is a deep ulcerative pyoderma usually caused by group A beta-hemolytic streptococcus (Streptococcus pyogenes). It usually presents in areas of damaged skin and in immunocompromised patients, and very infrequently is accompanied by general symptoms and bacteremia. We describe the case of a 41-year-old female patient with HIV infection who presented with fever and ulcerated lesions on the right ankle and left foot which had been developing for three weeks. Streptococcus pyogenes and Escherichia coli were simultaneously isolated from a culture of the skin biopsy sample and from blood cultures. Escherichia coli is of dubious pathogenic significance in this case.