A 4-year-old boy presented to the ER with a fever and abdominal pain for the past 2 months. Upon physical examination, he had cervical lymphadenopathy and hepatosplenomegaly. Full blood count revealed leukocytosis and anemia. Total WBC was 138 x 10x 3/uL, ( Promyelocytes 0%, Myelocytes 24%, Metamyelocytes 0%, neutrophils 86%, Eosinophils 3%, Basophils 1%, Monocytes 1%, Lymphocytes 9% ), Hemoglobin 9.4 g/dl and Platelet Count 356 x 10.e9/L. Bone marrow evaluation showed hypercellular bone marrow with granulocytic hyperplasia and predominant of myelocytes and segmented neutrophils. Eosinophils are prominent. No evidence of increased blasts or dysplasia. Flow cytometry performed on bone marrow aspirate and confirmed no increased blasts. BCR-ABL was positive by FISH and PCR. These findings were consistent with Chronic Myeloid Leukemia in Chronic Phase