A 20-year-old male patient presented with one week history of fever. On examination he was observed to be pale without jaundice. Bilateral upper cervical lymphadenopathy was observed. A complete blood cell count revealed anemia ( hemoglobin 10g/L ) and thrombocytopenia ( Platelet count 70,00/uL ). Total white cell count was normal ( 8700/uL ). Blood film examination showed 45% blast cells which were morphologically consistent with Lymphoblasts. In cytoplasm of about 20% blast cells, round uniform eosinophilic inclusions were seen identical to inclusions   seen in  granulocytes of  Chediak Higashi Syndrome. These were negative for myeloperoxidase stain but stained faintly with Periodic Acid Schiff reagent.

Such Pseudo Chediak Higashi type inclusions have been observed in Acute Myeloid Leukemia, Chronic Myeloid Leukemia , Myelodysplastic Syndrome and Leukemias of mixed lineage. However, they have been very rarely reported in Acute Lymphoblastic Leukemia. The clinical significance of this abnormality has not been clearly established.