The West Nile Virus (WNV) has rapidly emerged as an important etiology of meningoencephalitis in North America since 1999. Diagnosis of this infection on clinical grounds is difficult, as many signs and symptoms of infection are nonspecific. Although cutaneous manifestations are common in WNV-infected patients, these have not been described in detail nor are clinical images widely available. We describe 3 patients with WNV infections, two ambulatory, one hospitalized, who developed punctate erythematous, macular, and papular eruptions, most pronounced on the extremities. Histopathologic findings in one case showed a sparse superficial perivascular lymphocytic infiltrate, a feature commonly seen in viral exanthems but not previously reported with WNV infection. A literature review provides support that this punctate exanthem is a common cutaneous presentation of WNV infection.