A 27-year-old male presented with a one-month history of fever and bilateral hip pain of one-week duration. There was no bleeding diathesis, hepatosplenomegaly, lymphadenopathy, or history of prior transfusion. Complete blood count revealed: hemoglobin 5.6 g/dL, total leukocyte count 65.67 × 10⁹/L, platelet count 81 × 10⁹/L, and reticulocyte count 0.92%. Peripheral smear showed marked leukocytosis with a predominance of promyelocytes and myelocytes, macrocytic anemia, thrombocytopenia with occasional giant platelets, and dysgranulopoiesis. Bone marrow aspirate was hypercellular, with a majority of cells being promyelocytes, myelocytes, and dysplastic neutrophils. Promyelocytes were heavily granulated and exhibited distinctive rhomboid and quadrangular crystalline cytoplasmic inclusions. Classical bilobed promyelocytes and Auer rods were infrequent, and faggot cells were absent (Fig. 1). Myeloperoxidase (MPO) cytochemistry demonstrated strong positivity in most promyelocytes; however, some cells were MPO-dim or negative. The crystalline inclusions were not highlighted by MPO staining. Trephine biopsy revealed hypercellular marrow with sheets of immature myeloid cells. Flow cytometry showed an immunophenotype compatible with APL, with expression of CD33 (bright), CD13 (heterogeneous), CD117 (dim), MPO, CD64 (dim), and CD58. The blasts lacked CD34, HLA-DR, CD123, and lineage-specific B and T-cell markers. CD56 was positive in a subset (20.4%).