Abstract
Acute lymphoblastic leukaemia (ALL) is a prevalent cause of paediatric leukaemia. Patients with ALL typically exhibit symptoms such as fever, bleeding, weight loss, and bone pain. Blood investigations results predominantly show anaemia and pancytopenia with blast cells in the peripheral smear. While ALL primarily affects the bone marrow, it can also impact nearly every organ. There have been previous reports of extramedullary involvement of multiple organs in cases of ALL. This case represents a rare occurrence of (18)F-fluorodeoxyglucose (FDG) avid symmetrically enlarged kidneys as initial presentation of ALL.