Examination revealed bilateral axillary lymphadenopathy, which was missed on initial exam, and no cervical or inguinal lymphadenopathy. Excisional lymph node biopsy was performed, which showed large “popcorn cells” with co-expression of CD20 and OCT2, with a lack of CD15 and CD30, which were consistent with NLPHL. With this presentation of subacute aseptic meningitis with negative workup for infectious, autoimmune etiology, and absence of malignant cells in the CSF, in the setting of newly diagnosed NLPHL, the patient was diagnosed with paraneoplastic aseptic meningitis. The gene discussed is FUT4; the disease is aseptic meningitis.