Acute Lymphoblastic Leukaemia Presenting as Bone Marrow Necrosis

A young boy presented with recurrent anaemia which was initially attributed to malaria. On physical examination he was found to have generalized lymphadenopathy and hepatospleno-megaly. Peripheral blood showed neutropenia and bone marrow aspirate revealed bone marrow necrosis. Typical lymphoblasts were not seen in the peripheral blood until after intitiation of cytotoxic therapy. Needle aspirate of an enlarged lymph node and trephine biopsy established the diagnosis of acute lymphoblastic leukaemia.