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Context: Diffuse large B-cell lymphoma (DLBCL) is a neoplasm of medium-to-large B lymphoid cells with diffuse growth patterns. Although it is a potentially curable disease, around 40% of the cases are either refractory to primary treatment or relapse. Based on gene expression profiling (GEP), DLBCL can be classified as germinal center B-cell subtype (GCB) and activated B-cell subtype (ABC).

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Primary cutaneous B-cell lymphoma (PCBCL) has three subtypes, among those, the leg type variant is the rarest with the highest rates of relapse and recurrence making it an intriguing focus for researchers. Nevertheless, prior to framing a diagnosis solely based on the lesion's location, it is prudent to reconsider whether it is genuinely a primary cutaneous B-cell lymphoma (PCBCL) or if it aligns more closely with the more prevalent lymphoma variants such as diffuse large B-cell lymphoma (DLBCL) with cutaneous involvement. We are reporting a case of an 85-year-old African American lady, who presented with unilateral left leg DLBCL with cutaneous involvement.

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Bispecific antibody is a new treatment for hematological disease, especially for lymphoma, myeloma and acute lymphoblastic leukemia. This class of treatment presents the same kind of side effect as CAR-T cell which are immune-mediated. Nevertheless, infectious complication remains a major concerns with related mortality.

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