Early manifestations of lymphoproliferative disorders can be subtle and easily overlooked. Cough and pruritus frequently mimic benign dermatological or respiratory conditions.36 year old lady presenting to the clinic with a 6 week history of worsening cough, white phlegm, no systemic symptoms. Smokes 25 cigartettes daily. Normally fit and well.  She was on anxiolytics which were prescibed for pruritus one year ago. She had multiple presentations with generalized pruritus  for which she was prescribed  emolients, antihistamines and anxiolytics as this was attributed to her anxiety. But this did not settle. When asked about  her anxiety she did not seem  concerned. Examination  revealed multiple scratch marks . She had a CXR in view of the duration of her cough. Showed bilateral hilar lymphadenopathy and right sided pleural effusion. Blood tests showed  elevated white cells. She was discussed with  respiratory team, had a CT Thorax which showed extensive lymphadenopathy suggestive of lymphoproliferative disease and biopsy of lymph node suggesting Lymphoma.  She was started on chemotherpay and is stable.This case presented with unusal presentation of Lymphoma, cough and generalized pruritus without obvious lymphadenopathy. These symptoms are normally attributed to  allergies or viruses making the case diagnostically challenging.  Lymphomas present with B symptoms but pruritus alone without fever, night sweats or weight loss can be misleading.  This case highlights how easily malignancies can be masked by everyday symptoms.Symptoms that do not resolve with initial management warrant re-evaluation. The patient had multiple presentations with pruritus and given treatments which were not working. Her cough  was present on most days but was not given importance.   Importance of recognizing non-specific but persistent symptoms and considering a broader differential diagnosis, including less common ones like lymphoma.In cases with persistent pruritus and cough  CBC, CRP & CXR should be considered. Missing early opportunitues for investigation can contribute to delayed diagnosis.This is a strong example of how common presentations can hide serious disease and importance of educating others for diagnostic curiosity. Brings to light ways of potentially imroving practice by implementing quality improvement initiatives around, persistent symptoms, red flags check list, documentation and  follow up protocols.