Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 15 4 2020 10 31 183 188 Roya Sattarzadeh Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Saeed Ghodsi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Masoud Eslami Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Reza Mollazadeh Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Reza Safaei Nodehi Cancer Research Center, Iran Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran. Zahra Hosseini Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. 2019 08 16 2021 01 28 Cutaneous T-cell lymphomas constitute a rare category of non-Hodgkin lymphomas, which may involve the heart in the timeline of their natural course as an infrequent picture with a poor prognosis. Syncope, either due to outflow obstruction or conduction block, is also an uncommon presentation of cardiac metastasis. We herein describe a 35-year-old man, who presented with weight loss, dyspnea of 6 months’ duration, an indolent skin ulcer in the left flank, lower limb deep vein thrombosis (DVT), and recurrent syncope. He underwent implantation of a permanent pacemaker due to a complete heart block and received anticoagulants for the DVT. Skin biopsy demonstrated a T-cell lymphoma. The syncopal episodes ceased thereafter. Echocardiography and computed tomography scan revealed cardiac metastasis, which responded to systemic chemotherapy. In the first follow-up visit after 3 months, he was still pacemaker-dependent. However, the DVT was partially resolved, and the symptoms had disappeared. https://rhythm.tums.ac.ir/index.php/jthc/article/view/1127 https://rhythm.tums.ac.ir/index.php/jthc/article/download/1127/929