PT - JOURNAL ARTICLE AU - Arihant Jain AU - Sweta Rajpal AU - Man Updesh Singh Sachdeva AU - Pankaj Malhotra TI - Numb chin syndrome as a presenting symptom of diffuse large B-cell lymphoma with secondary myelofibrosis AID - 10.1136/bcr-2017-221245 DP - 2018 Jun 21 TA - BMJ Case Reports PG - bcr-2017-221245 VI - 2018 4099 - http://casereports.bmj.com/content/2018/bcr-2017-221245.short 4100 - http://casereports.bmj.com/content/2018/bcr-2017-221245.full AB - Diffuse large B-cell lymphoma (DLBCL) is the most common non-Hodgkin’s lymphoma that classically presents with rapidly enlarging lymph nodes. We present a 59-year-old man with unusual clinical presentation of numb chin syndrome (NCS) as the first symptom of disease. On evaluation, he was found to have diffuse extranodal skeletal involvement in the form of lytic-sclerotic lesions and minimal lymphadenopathy. Bone marrow biopsy revealed a poorly differentiated tumour with infarction and extensive myelofibrosis. This was subsequently proven to be DLBCL of germinal centre type on immunohistochemical stain. NCS should alarm the clinician to investigate for an advanced underlying malignancy. Extensive myelofibrosis, though described in carcinomas and low grade lymphomas, may also be seen in high grade DLBCL.