The patient’s history of night sweats and laboratory findings of DIC, lactic acidosis, and hypoglycemia in the setting of mediastinal lymphadenopathy on CT imaging were suggestive of malignancy. The patient was intubated due to work of breathing and supported with high minute volume-assisted ventilation and IV bicarbonate. Hypoglycemia was stabilized with concentrated glucose products, and DIC was treated with transfusion of blood components. Upon stabilization, an endoscopic ultrasound-guided lymph node biopsy sample was obtained. With biopsy results pending, the lactic acidosis worsened (arterial pH < 7.20), and empiric methylprednisolone and thiamine were started to treat the suspected lymphoma. Biopsy results suggested extranodal NK/T-cell lymphoma, and a modified rituximab, chemotherapy regimen of cyclophosphamide, doxorubicin, vincristine, and prednisone was initiated. Shortly after initiation of therapy, the patient’s glucose level stabilized, and DIC required only infrequent transfusions. The lactic acid level trended down and reached a nadir on day 13 (1.3 mmol/L). On day 14, lactate acid levels again increased, hypoglycemia worsened, and DIC became more active, all indications of treatment failure. The patient continued to deteriorate and died on hospital day 19.