De novo CD5-positive (CD5+) diffuse large B-cell lymphoma (DLBCL) is a highly aggressive subtype of DLBCL with a high incidence of misdiagnosis when spinal cord compression is the initial symptom. We report a case of a 45-year old man with de novo CD5+ DLBCL primarily presenting as spinal cord compression. Unfortunately, this patient was resistant to rituximab-based therapy, which indicated a poor prognosis.