The patient was a 22 month old female of Asian extraction who presented to the New York Presbyterian Hospital Emergency Room with an   abrupt onset of  fever and malaise. A peripheral blood assessment revealed a white blood count of   56000 with many highly atypical T  cells concerning for acute leukemia. Her bone marrow biopsy showed an extensive infiltrate of atypical T lymphocytes.

The patient subsequently developed a skin rash clinically held to represent leukemia cutis

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