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BACKGROUNDMetastatic spinal cord compression (MSCC) is a well-recognized complication of underlying malignancies, however, MSCC is rarely described in acute leukemia. CASEWe report a 24-year-old female presenting with low backache, right lower limb radicular pain, right foot drop, and loss of bladder sensation, suggestive of a cauda-cona syndrome. Magnetic resonance image revealed an enhancing pre-/paravertebral lesion extending from L5-S3 level with destruction of vertebral bodies and intraspinal infiltration. Peripheral blood smear revealed atypical cells, which was confirmed on bone marrow analysis as vacuolated myeloblasts. Accordingly, she was diagnosed with acute myeloid leukemia (AML) type M4 with spinal myeloid sarcoma leading to cord compression. She was started on a cytarabine-adriamycinbased chemotherapy regimen. Following 2 cycles, her symptoms improved, however, she succumbed to febrile neutropenia following 4 cycles of treatment. CONCLUSION MSCC, although rare, can be a presenting complaint of AML resulting from cord compression by spinal myeloid sarcoma.