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A 38 year old Nepalese man presented with a large red tender plaque on his back of 15 days duration. He had a history of fever, cough, chest pain and haemoptysis for 4 months. On examination, he also had pallor lymphadenopathy and hepatomegaly. Investigations revealed anaemia, marked leucocytosis with 45% atypical cells and thrombocytopenia. Chest X-ray showed consolidation and bone marrow examination revealed abnormal cells. Skin biopsy had features of cutaneous T-cell lymphoma (CTCL). We report this rare presentation of CTCL with simultaneous visceral and haematological involvement.