Mycotic pseudoaneurysm is a rare and serious disease that may manifest clinically in a subtle and gradual manner. Here, we report a challenging case of a 47-year-old male with diabetes, stage 5 chronic kidney disease, and a history of stroke resulting in left hemiplegia. He presented to the neurology outpatient department (OPD) with lethargy, slurred speech and weakness in his right lower extremity. He was initially suspected of having an acute ischemic stroke. The development of fever and a painful mass in the right thigh after hemodialysis alerted us to an occult mycotic pseudoaneurysm of the superficial femoral artery (SFA), prompting immediate treatment.