We report a case of a temporal artery pseudoaneurysm in a patient with a history of human immunodeficiency virus (HIV) infection, hepatitis C infection, cocaine dependence, neurosyphilis, and remote head trauma. The diagnosis was made on gray scale and color Doppler sonography, and subsequent resection was performed. Histologic analysis showed temporal arteritis with no giant cells. Although most reported cases of temporal artery pseudoaneurysms are attributed to prior trauma, we discuss additional potential etiologies for temporal artery pseudoaneurysm in the setting of temporal arteritis.