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B-Acute lymphoblastic leukemia (B-ALL) with intracytoplasmic inclusions in lymphoblasts is an unusual presentation. Here, we present a pediatric case of B-ALL with ETV6-RUNX1 rearrangment and unusual blast morphology showing distinct intracytoplasmic eosinophilic inclusions. The case is reported for its rare occurrence, specially in childhood and its persistence in the post-induction marrow aspirate, which subsequently showed poor initial treatment response despite the presence of good prognostic molecular markers. The current literature is reviewed.