Intravascular large B-cell lymphoma (IVLBCL) is a rare form of diffuse large B-cell lymphoma that preferentially grows intravascularly within the capillaries and often has a fatal course. Most of the patients have advanced and disseminated disease at the time of presentation. It is often arduous to make the diagnosis during the antemortem period due to the multitude of presenting symptoms. We report a case of aggressive IVLBCL which presented with a myriad of complaints and acidosis and had a rapid clinical decline.