Plasmablastic lymphoma (PBL) is an uncommon aggressive malignancy that is associated with patients with human immunodeficiency virus (HIV), other immunosuppression conditions, or in elderly patients, that tends to appear in the oral cavity. PBL accounts for 2.6% of all HIV-associated non-Hodgkin lymphomas. We describe the case of a chemotherapy-treated patient with HIV-associated plasmablastic lymphoma who presented with a three-month history of left facial swelling. Features seen on different imaging modalities including panoramic and multi-detector computed tomography (MDCT) were suggestive of a malignancy and/or an inflammatory lesion. However, histopathological examination revealed an aggressive immunoblastic neoplasm, consistent with AIDS-associated PBL. PBL is hard to diagnose, rapidly progressive, with overall poor prognosis among HIV-infected patients, and often rapidly fatal. The maxillofacial radiologist must be aware of the existence of this relatively newly described lymphoma as it is associated with immunosuppression and may be misdiagnosed as other pathoses.