case_images: PMC11822214_01
case_images: Ecchymosis on the leg of the patient
case_images: cureus-0017-00000077400-i01.jpg
case_images: PMC11822214_01_cureus-0017-00000077400-i01.jpg
case_images: FIG1
case_images: In February 2024, the patient presented for evaluation at the emergency department due to back pain, and upon examination, a non-traumatic ecchymosis on the left leg and abdomen was revealed (Figures 1, 2).
case_images: Ecchymosis on the abdomen of the patient
case_images: cureus-0017-00000077400-i02.jpg
case_images: PMC11822214_01_cureus-0017-00000077400-i02.jpg
case_images: FIG2
case_images: In February 2024, the patient presented for evaluation at the emergency department due to back pain, and upon examination, a non-traumatic ecchymosis on the left leg and abdomen was revealed (Figures 1, 2).
case_images: Bone marrow aspirate smears shows moderate cellularity with few spicules (small fragments around cells), suggesting probable hemodilution of the submitted sample. . A (black arrow): There is predominance of blasts, including a majority of small-to-medium-sized cells with high nucleocytoplasmic ratio.
  B (red arrow): Nuclei are mostly rounded, some of them are clefted, and occasionally contain open chromatin whitish nuclei. No Auer rods are seen. Megakaryocytes are rare.
  C (Blue arrow): Erythropoiesis and granulopoiesis are represented by scattered elements. Plasma cells and lymphocytes are not increased in number.
case_images: cureus-0017-00000077400-i03.jpg
case_images: PMC11822214_01_cureus-0017-00000077400-i03.jpg
case_images: FIG3
case_images: Bone marrow aspiration (Figure 3) demonstrated moderate cellularity with blast predominance and small to medium-sized nuclei with high nucleocytoplasmic ratio, predominantly rounded, without Auer rods, consistent with acute leukemia.
case_images: Normocellular bone marrow aspirate of our case of B-cell ALL, showing no increase in blast cells, most compatible with remission. ALL: Acute lymphoblastic leukemia
case_images: cureus-0017-00000077400-i04.jpg
case_images: PMC11822214_01_cureus-0017-00000077400-i04.jpg
case_images: FIG4
case_images: Bone marrow smears (Figure 4) obtained after induction revealed a normocellular bone marrow with no increase in blast cells, indicating remission.