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Bacillus cereus (B. cereus)is a rare cause of invasive infection. To our knowledge, we report the first case of a human immunodeficiency virus (HIV)-infected individual diagnosed with a B. cereusendovascular infection. We also present the largest literature review to date of reported B. cereusendovascular infections. A 65-year-old woman with well-controlled HIV and active injection drug use presented with an acute febrile illness. Blood cultures for multiple consecutive days after admission were positive for nonanthrax Bacillusspecies despite appropriate intravenous antibiotic therapy. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry was used to identify B. cereus. Our analysis of previous cases reveals injection drug use and prosthetic heart valves as major risk factors for B. cereusendovascular infections, and we propose that HIV status does not play a significant role. In addition, the use of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry for a rapid and accurate identification of this organism highlights the potential of this technology, and providers should be aware of its availability and utility.