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Congenital B-cell Acute Lymphoblastic Leukemia with Congenital Rubella Infection. BACKGROUND: Congenital B-cell Acute lymphoblastic leukemia (ALL) is a rare malignancy. CHARACTERISTICS: A newborn infant presented with purpuric spots and ecchymotic patches, blueberry muffin rash, depressed neonatal reflexes, respiratory distress and hepatosplenomegaly. Peripheral smear revealed atypical blast cells. Serum ELISA was positive for Rubella IgM and IgG antibodies. Flow cytometry suggested congenital B-cell ALL. OUTCOME: The baby died after 3 days due to suspected intracranial hemorrhage. MESSAGE: Congenital leukemia may be rarely associated with congenital rubella infection.