Abstract
This case report describes a case of an unusual initial presentation of acute lymphoblastic leukemia in a 22 year male. He presented with intractable pruritus, weight loss and loss of appetite for 1 month in the gastroenterology outpatient department. On investigating, his liver function test was deranged .Magnetic resonance cholangiopancreatography was suggestive of focal narrowing of proximal common bile duct with dilated intrahepatic biliary radicles. A complete serological evaluation for infective and autoimmune profile was negative. Patient underwent image guided liver biopsy. The core of biopsied liver showed infiltration by nests of round to oval tumor cells with markers consistent with B lymphoblastic leukemia /lymphoma not otherwise specified.

Key words: Acute lymphoblastic leukemia, liver, B lymphoblastic lymphoma