Intravascular large B-cell lymphoma (IVLBCL) is a rare and aggressive cancer in which neoplastic B-cells proliferate inside blood vessels. It commonly affects the skin, nervous system or liver with spleen, but rarely lymph nodes or diffuse interstitial lung disease (DILD). A 62-year-old man presented with recurrent fever, progressive shortness of breath, bilateral interstitial lung disease on chest CT and generalized lymphadenopathy on ultrasound. Initial treatment brought improvement, but the disease recurred. Lymph node biopsy confirmed IVLBCL with intravascular and intrasinusoidal infiltration of lymphoma cells with preserved nodal architecture. Tumor cells showed diffuse strong expression of CD30 in ∼70% of cells. This case expands the spectrum of manifestations of IVLBCL to include DILD and generalized lymphadenopathy.