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An 80 year old woman underwent vitrectomy for recurrent uveitis, demonstrating lymphocytic vitreous fluid. Less than a month later skin biopsy confirmed the diagnosis of extranodal NK/T cell lymphoma. Chemotherapy with SMILE (steroiddexamethasone, methotrexate, ifosfamide, L-asparaginase, and etoposide) was poorly tolerated despite reduced doses, while pembrolizumab was ineffective.