A 42-year-old Egyptian man was hospitalized for over a decade with a mistaken diagnosis of lepromatous leprosy. Aspergillus niger was isolated from diffuse skin lesions, and the patient responded to nystatin therapy. This is one of the few reports of disseminated primary cutaneous aspergillosis. It emphasizes the need to consider cutaneous mycotic infections in the differential diagnosis of lepromatous leprosy.