We present a case of giant bilateral iliopsoas bursitis (IB) in a patient with Human Immunodeficiency Virus (HIV) who presented to the emergency department with bilateral hip pain and fever. He was initially worked up for septicemia. Inflammatory markers at the time of admission were elevated. He was started on IV antibiotics. Contrast-enhanced CT scan of the abdomen and pelvis demonstrated a retrocrural collection secondary to discitis/osteomyelitis, as well as large bilateral multilocular collections deep to the iliacus muscle concerning for bilateral septic giant IB. The collections were drained and grew MRSA and tailored antibiotics were started. Despite adequate treatment he succumbed to his illness. Knowledge of this entity is important, as delay in diagnosis and management of septic IB can result in a fatal outcome, especially in immunocompromised patients.