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2 This article aims to report the association between acute lymphocytic leukaemia and AIDS in a patient admitted in a general hospital. Case presentation This is a case report of a white 37-year-old male patient from S?o Bernardo do Campo, S?o Paulo, Brazil. A married shopkeeper, he reported of low back pain that irradiated to the lower limbs with progressive worsening for the past 30?days. He had a weight loss of 4?kg during this period. He also reported unmeasured fever unrelated to any other associated symptom. The patient was a smoker (20 cigarettes/day) for 20?years and a regular alcohol consumer (one dose of liquor/day) for an imprecise period of time. Ex-marijuana and ex-cocaine user, but is clean since 5?years. He had unprotected sexual relations and his body bore several tattoos. During the week prior to admission in the emergency department of S?o Bernardo County Hospital affiliated to the ABC Medical School, he presented difficulty in walking and sitting. There was no improvement with the use of analgesics and anti-inflammatory drugs. His medical history did not show any significant epidemiological alterations. Guided by the patient��s history records, an HIV test was conducted and the result was positive. Other tests were required as shown in table 1. Table?1 Laboratory analysis Four days after his admission the patient��s condition evolved to paraplegia and urinary retention, loss of lower limbs reflexes and reflex hypoactivity of upper limbs. The spine tomography showed no alterations. There was no spinal fluid collection owing to a thrombocytopenia. Moreover, with the clinical worsening of the patient, his removal for the performance of a spinal MRI was not possible. Initial laboratory analysis showed bicytopenia that worsened throughout the period of admission. Haemotransfusion was made necessary owing to the constant decrease in haematimetric and platelet levels. There were no alterations in the aldolase values, reticulocyte count and blood cultures. Hepatitis B serological test result was acute positive and an active lesion caused by the virus was highlighted in the diagnosis findings. A myelogram was performed which revealed 40% cellularity with granulocytic series 10%, erythrocyte series 14%, lymphocyte series 8% and blasts 68%. The conclusion reached was hypercellular bone marrow with reduction in megakaryocyte series and a massive blast infiltration. The patient evolved with respiratory insufficiency and worsening of the radiological pattern. Ruxolitinib Orotracheal intubation was made necessary subsequently leading to death. Differential diagnosis The presence of dacryocytes on the peripheral blood smear suggests myelodysplasia with hypocellular bone marrow and an increase in fatty tissue. Bone marrow aplasia is characterised by the lack of production of young cells. The bone marrow biopsy confirms this hypothesis. Acute leukaemia patients have a hypercellular bone marrow owing to the presence of blats >25%.