A 58 years old  white male has a PMH of ulcerative colitis and Cohn's disease with ileostomy placement. Recently  he presented to the clinic with weight loss, diffuse lymphadenopathy, and pain in bilateral hips and arms. He also had a 3 month history of nodules and a swollen left arm.  The first nodule to appear was below his left axilla and then more appeared on his left chest, right axilla, right jaw, right groin area, above his right eye and in his scalp in the left temporal region.  Usually the nodules would start out red and purple and then they have all been progressively getting larger. He has had worsening lymphadenopathy involving his left axilla and a mass on his left temple over the the past 3 months. CT scan of his C/A/P showed involvement of numerous lymph nodes, significant tumor replacement of the liver, and bony involvement. His LDH is 2609. His alk phos is 434. He is hypercalcemic as well.