A 15 year old with precursor B Acute Lymphoblastic Leukemia, who is currently receiving maintenance chemotherapy, has been complaining of back pain. The episodes “come and go” and have no specific pattern of occurrence. The pain is not associated with spinal procedures, trauma or any known triggers. There is no numbness or tingling associated with the pain. Physical exam is normal; physical therapy has not improved the symptoms. He has recently developed fevers along with the pain. He is noted to have a skin rash on his arm and his shoulder as well. As part of the work-up for the back pain, a full spinal MRI is done. On the cervical spine there are focal areas of enhancement noted in the cerebellum. The remainder of the spinal MRI is normal.