Abstract
Introduction and importance Ewing's sarcoma is an aggressive malignancy primarily affecting skeletal system in children and young adults. CASE PRESENTATION: We report an unusual case of Ewing sarcoma in a 14-year-old boy with clinical and radiological features of rapid onset metachronous skeletal metastasis (within 4 weeks of diagnosis). CLINICAL DISCUSSION: Although the deterioration of symptoms was very rapid, it is unusual to note that in the presence of such widespread metastatic disease the lungs per se remained uninvolved. CONCLUSION: We describe a unique case of metastatic Ewing's sarcoma who showed rapid systemic disease progression with widespread skeletal metastases (and CNS involvement) but without any evidence of pulmonary involvement.