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A 72-year-old male with nonspecific symptoms was found to have pancytopenia and transaminitis. The pancytopenia began to improve early in the hospital course without specific treatment. A liver biopsy, obtained later to determine the etiology of the transaminitis, eventually confirmed CD5+ diffuse large B cell lymphoma (DLBCL). DLBCL typically presents with painless lymphadenopathy and constitutional symptoms although it may also present as a rapidly enlarging mass in any part of the body. However, in rarer cases its presentation can be misleading. Conditions such as HLH or viral infections, can confound a patient’s presentation and delay the diagnosis. High index of suspicion is warranted for the diagnosis of DLBCL in atypical cases to prevent mortality associated with late diagnosis. Early recognition and biopsy of involved organ, in the absence of clear etiology, is vital for timely diagnosis and prompt treatment to achieve a favorable cure rate. CD5+ DLBCL may have unusual involvement of extra nodal organs such as the liver and may need further investigations.