Patients with end stage renal disease (ESRD) are predisposed to malignancy. A patient who presented with a persisting fever, episodically above 38 degrees C, of unknown origin is described. The diagnosis of the illness remained elusive, over repeated hospital admissions and comprehensive investigations for over 11 weeks, until her last admission when the patient finally represented with features of acute liver cell failure and succumbed shortly afterwards. A liver biopsy revealed high grade lymphoma, an uncommon presentation for lymphoma. While malignancy is increased in dialysis patients, lymphoma is a relatively uncommon malignancy described. This case is a rare incidence of diffuse Non-Hodgkin's Lymphoma (NHL) isolated to the liver, causing fever, liver cell failure and death in a hemodialysis patient.