We present a case of an acute HTLV-1 leukemia in a 33-year-old Grenadian immigrant. Her diffuse skin nodules, and her coming from an area endemic for HTLV-1, namely the Caribbean made the clinical diagnosis of HTLV-1 leukemia/lymphoma more feasible. Her disease was rapidly progressive, she having survived for one month, and fits into the acute classification of ATLL as proposed by Shimyoyama M. Immigrants from areas endemic for HTLV-1 who presents with skin rashes should be investigated for HTLV-1 neoplasms.