The patient was a 22-year-old student with a history of fever and body ache for the past 2-3 months. Pallor and tenderness over the rib cage were the only positive findings on clinical examination. Laboratory findings are detailed in Table 1. Peripheral smear examination showed 90% abnormal promyelocytes with strong cytochemical myeloperoxidase positivity. Promyelocyte morphology resembled case 1. In addition, maturing myeloid cells, hypogranular and hypolobated neutrophils were also present (Figure 2, E & F). The patient was immediately started on ATO based on the morphological suspicion of APL. The patient did not develop any bleeding manifestations. The immunophenotype was similar to case 1 and 4, however, unlike those cases, CD56 was dim (Table 1). FISH did not show t(15;17), but the break-apart probe revealed RARA variant translocation. After 11 days of ATO and following confirmation of ZBTB16-RARA fusion by PCR, the patient was shifted to daunorubicin and cytarabine-based induction therapy. Remission was not achieved post induction (Table 1), and the patient was started on consolidation therapy with HiDAC.