Abstract
THE INITIAL symptoms of acute leukemia are often those of a severe infection, with high fever, malaise, headache, and prostration. Acute upper respiratory infection or acute tonsillitis is frequently diagnosed in the beginning of the disease. The present case presented as acute otitis media with mastoiditis complicated by sinus thrombosis, the leukemia being diagnosed only at autopsy. Report of Case A boy of 11 was first seen in the outpatient clinic complaining of left earache which had started 17 days earlier with general malaise; 10 days after onset his face suddenly became asymmetric. During this time there was no discharge from the ear, the temperature was not taken, and the patient continued to be ambulatory. Otoscopic examination revealed acute left otitis media with a red bulging drum and tenderness on palpation over the left mastoid area. Signs of peripheral facial palsy were evident on the left. A left myringotomy was

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