A 57-year-old woman presented to a community hospital with complaints of headache and photophobia, cough, and nausea. Workup included a lumbar puncture to rule out meningitis. Spinal fluid analysis was unremarkable for infection or malignancy. Her initial CBC count showed a normal total WBC count, but the differential was noted to contain 75% blasts. The patient was transferred to the hematology/oncology service at our hospital, where a bone marrow biopsy was performed. Within 24 h, progressive fevers, respiratory distress, and hypoxemia developed, and the patient was transferred to the ICU.