A 78-year-old Caucasian male in good health presented with 2 weeks of diplopia and right sided headache. Examination found right incomplete ptosis and limited elevation, depression, and adduction of the right eye with no pupillary involvement. Three months later he exhibited complete ptosis, CN VI nerve palsy, and V1/V2 nerve palsy on the right. Routine labwork was unremarkable. Viral serology and myasthenia antibody testing were negative. MRI revealed heterogeneous enhancement of the right cavernous sinus with extension to right orbital apex. LP showed slightly elevated protein level with normal cell count. Cytology and PCR of CSF were unremarkable. Transsphenoidal biopsy revealed lymphocytic inflammation but no microorganisms or malignancy. Two months later he returned with worsening vision, tremulousness, and gait imbalance. Repeat MRI showed enhancing hemorrhagic masses in the anterior right temporal lobe, T2/FLAIR hyperintense signal along the left lateral ependymal surface, and the suspected right cavernous sinus mass was unchanged. PET scan revealed increased FDG uptake of the left cerebellum and right temporal lobe and mild FDG activity of lung bases. Right anterior temporal lobectomy was performed which revealed EBV+/CD30+ diffuse large B-cell lymphoma. Patient expired post-op day 14 from persistent infection leading to respiratory failure.