Introduction: Covid 19 was declared as a pandemic by WHO in December 2019. Since then the whole world has been battling this crisis with large number of deaths worldwide. India reported its first case in March 2020 in Kerala [1]. Experimental research findings indicate that an exaggerated immune response and a strong cytokine storm, which may include high levels of granulocyte-macrophage colony-stimulating factor and interleukin-6 (IL-6), are activated in severe COVID-19 [3, 4]. This can lead to a clinical presentation of pancytopenia and HLH like features. Case: A 15-year-old female presented with fever and breathing difficulties to the emergency. She had tachypnoea and tachycardia but no organomegaly, lymphadenopathy or any other relevant examination findings. Routine lab investigations revealed pancytopenia. And day 1 peripheral smear showed virocytes. She was evaluated for COVID-19 and came out to be positive. On treatment her symptoms subsided but pancytopenia persisted. Hence a repeat peripheral smear examination and done on day 10 post admission which showed 8% blasts. BMA/BMB was advised with serum ferritin levels. Result: A diagnosis of acute leukemia was made on imprint smears as bone marrow aspiration was haemodiluted and paucicellular. Biopsy showed presence of sheets of histiocytes with hemophagocytosis admixed with blasts. A final diagnosis of Acute leukemia with Hemophagocytosis was made and serum ferritin advised to rule out HLH. Conclusion: The case turned out to an ALL with HLH. Hence, we realised that the cytokine storm in COVID -19 can at times mask the underlying major etiology and patient might just present with HLH. We conclude it is very important to analyse each case of Covid with great alacrity