Acute lymphoblastic leukemia presenting as cyclic neutropenia

Clinical and laboratory parameters usually allow an easy diagnosis of acute lymphoblastic leukemia in most cases. Difficulty arises, however, when presentation is atypical. A young child with membranous tonsillo-pharyngitis secondary to an isolated neutropenia is reported. The neutrophilic count later showed fluctuations reminiscent of cyclic neutropenia. Bone marrow examination revealed the true nature of underlying disorder.