A 67 year old female presented with generalized weakness, falls and recurrent high grade fevers for 5 - 6 weeks. Physical findings included high grade temperature, lower extremity weakness and diminished reflexes. An extensive work-up for fever of unknown origin (FUO), including PET-FDG scan, did not yield any occult infectious or neoplastic process. Ultimately a temporal artery biopsy was planned to rule out temporal arteritis. The histopathology of temporal artery was normal while the vein showed lymphoid proliferation consistent with Angiotropic large cell lymphoma (ALCL).