Successful Resolution of Compartment Syndrome in a Pediatric Patient With B-cell Acute Lymphoblastic Leukemia

We report a case of a 17-year-old male presenting with acute compartment syndrome (CS) of the lower extremity as the initial manifestation of CRLF2-positive, Ph-like B-cell acute lymphoblastic leukemia (B-ALL), without evidence of leukemic infiltration or hematoma. Emergent fasciotomy was performed, followed by cytoreduction with hydroxyurea to allow wound healing before induction chemotherapy. The patient fully recovered and completed induction without complications. This case highlights the importance of recognizing CS as a rare presenting feature of leukemia, and supports hydroxyurea bridging as a viable strategy when immediate chemotherapy is contraindicated to support surgical recovery.