A 62 year old man presented with fullness and later pain in the left upper abdominal quadrant of a few weeks’ duration, which was refractory to commonly used analgesics. The patient also presented low-grade fever in the afternoons, night sweats and fatigue. Initial laboratory evaluation disclosed a mild anemia (Ht=32%) and leukocytosis (WBC=13,500/μL). Physical examination revealed mild skin and conjuctival pallor, hepatomegaly (the liver was palpable 3 cm below the costal margin), splenomegaly (7 cm below the costal margin) and lymphadenopathy (cervical and inguinal lymph nodes measuring 0.5x0.5 cm). Laboratory tests were as follows: Ht=30.5%, Hb=9.8 g/dL, reticulocytes=1.3%, WBC=12,500/μL [polymorphs 32%, lymphoid cells 60% (fig. 1), monocytes 7%, basophils 1%], platelets=96,000/μL, glucose=110 mg/dL, BUN=52 mg/dL, creatinine=1.2 mg/dL, SGOT=61 UI/L, SGPT=50 UI/L, billirubin=1.3 mg/dL, alkaline phosphatase=95 UI/L, γGT=217 UI/L, LDH=980 UI/L, total protein 7.8 g/dL with diffuse hypergammaglobulinemia on electrophoresis). Immunochemically the lymphoid cells of the peripheral blood were positive to acidic phosphatase, and the positivity was resistant to tartaric acid. Immunophenotyping was positive for Smlg (κ chain), HLD-DR, CD11c, CD19, CD20, mCD22 and CD39, while it was negative for CD2, CD5, CD10, CD25 and HC2. The bone marrow smear showed relatively good cellularity, with scattered foci of infiltration by the same lymphoid cell seen in the peripheral blood, decrease of all lineages and rare productive megakaryocytes. Chromosomal studies were normal. After initiation of the appropriate treatment and while the patient had thrombocytopenia he presented with abdominal pain and two days later a localized skin rash (fig. 2). The rash resolved quickly with treatment, leaving a bruise-like lesion and later a color change in the area.