Introduction: Kaposi sarcoma is a well-recognized vascular lesion that primarily affects the skin, following the course of three stages; patch, plaque and nodules. It is strongly associated with human herpes virus 8 (HHV8) and Human immunodeficiency virus (HIV). Nevertheless, it is a rare presentation in immunocompetent individuals. Case presentation: A seronegative middle-aged Saudi man with history of nasal Kaposi sarcoma, presents with a recurrent dusky brown nodular lesion on the thigh. Histopathologic examination showed a spindle cell lesion with intervening slit-like vascular spaces that are immunoreactive to HHV8. Conclusion: Kaposi sarcoma can occur and recur in the setting of HIV-seronegative healthy individuals, whom they present with a nodular vascular skin lesion. We recommend the assessment of HHV8 status in such lesions, despite seronegative HIV status.