60-year old HIV-negative man presented to a local emergency department in with anemia, splenomegaly, and lymphadenopathy of right neck and axillary region. He underwent excisional lymph node biopsy, which showed non-specific reactive changes. One year later, labs revealed a mild leukocytosis (16,200 per microliter) with absolute monocytosis (6,100 per microliter). Anemia workup, including bone marrow examination was unrevealing. The patient underwent a second excisional lymph node biopsy of a right axillary lymph node.