Extranodal Natural Killer/T-cell lymphoma, Nasal Type is a rare and aggressive Non-Hodgkins Lymphoma associated with the Epstein-Barr Virus and Hemophagocytic Lymphohistiocytosis. We describe three patient presentations at two medical centers in New Orleans, Louisiana, observed within a six-month interval. Although the disease has a lower incidence in the US than in Asia and Latin America, the incidence appears to be on the rise. Due to the spectrum of clinical presentations and low index of suspicion for the disease, presenting signs and symptoms of ENKL may be misattributed to a non-neoplastic condition, resulting in a delay in diagnosis. Increased awareness of the clinical and pathologic spectrum of ENKL, particularly in non-endemic areas, remains an essential means of preventing delay in diagnosis and early initiation of treatment.