A low-birth-weight neonate with respiratory distress subsequently developed neonatal jaundice with hyperbilirubinemia, sepsis, and hemolysis. Peripheral blood smear examination on day 7 of life showed normal leukocyte morphology. In contrast, a repeat smear on day 10 revealed distinctive refractile, golden-yellow bilirubin crystals within the cytoplasm of neutrophils and monocytes, highlighting an unusual intracellular deposition of bilirubin.