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Malignant histiocytosis is a rare condition with variable clinical presentation and prognosis. Its diagnosis requires high index of suspicion and further evaluation. Thus, it poses a diagnostic as well as management challenges especially in resource poor setting. The objective is to highlight the diagnosis and treatment challenges in the management of malignant histiocytosis so that physicians can diagnose it early and initiate appropriate treatment. Our patient is a 35-year-old man who presented with chest wall mass, dyspnoea and right cervical lymphadenopathy He was initially being evaluated for lymphoma. Biopsy of the lymph nodes was done twice in different hospitals and that of the chest wall mass done once. Histological diagnosis was arrived at with the aid of immunohistochemistry three months after his first presentation to the hospital. The patient was then commenced on chemotherapy and showed remarkable improvement on the short-term basis. Malignant histiocytosis is a rare disease laden with management challenges. Despite that, its diagnosis and treatment can be achieved even in resource poor setting with high index of suspicion, team work and good laboratory support.