Abstract
A 40-year-old female who was an ex-intravenous drug user on methadone presented to the Emergency department reporting all over body pain and was subsequently found to have a diagnosis of non-Hodgkin's B cell lymphoma in the absence of lymphadenopathy. She did not respond to chemotherapy and pain management was difficult. This case demonstrates three things. Firstly, clinicians should be aware that ex- or current intravenous drug users presenting with pain may have significant pathology. Secondly, pain management in patients on methadone can be difficult. Lastly, the case describes an atypical but recognised presentation of lymphoma with bone involvement but no lymphadenopathy.