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Facial swellings could arise symmetrically due to underlying congenital; or acquired disorders such as renal, cardiac, endocrine, or storage disorders, mostly the manifestations of systemic illness in the face. It requires a high index of clinical suspicion by an alert clinician to distinguish the emergency and diffuse inflammatory causes as in lymphedema, hay fever, etc., or an abscess or dental etiologies which are mostly well lateralized from long-standing causes which may be vascular malformations, fibrous dysplasias or slowly progressive and sinister swellings due to malignancies. These cause significant distress to both the patient and the treating clinician. This case highlights the need to look beyond the usual or common causes since these underlying diseases may be sinister yet highly treatable and ameliorate the patients' symptoms dramatically. This case highlights a mature T-cell cutaneous lymphoma who presented repeatedly with little relief from treatment initially offered.

This case report describes a 38 year-old lady with the clinical, histopathological, and immunohistochemical (IHC) changes of subcutaneous panniculitis-like T-cell lymphoma (SPTCL). The IHC findings revealed CD8 + and CD56 - cells, which are indicative of tumors which have an indolent course. Our patient is being managed with tapering doses of corticosteroids for the last nine months with good improvement.