Congenital Leukemia - A Diagnostic Dilemma

A 6 day old newborn presented with fever, lethargy, poor suck and mild hepatosplenomegaly, features suggestive of sepsis. Septic work up was negative. Peripheral smear revealed hyperleuko-cytosis, thrombocytopenia and presence of atypical cells. Bone marrow examination revealed increased myeloblasts. Other causes of leukemoid reaction were ruled out and a final diagnosis of congenital leukaemia was made.