Introduction and importance Ewing's sarcoma is an aggressive malignancy primarily affecting skeletal system in children and young adults.
Case presentation: We report an unusual case of Ewing sarcoma in a 14-year-old boy with clinical and radiological features of rapid onset metachronous skeletal metastasis (within 4 weeks of diagnosis).
Clinical discussion: Although the deterioration of symptoms was very rapid, it is unusual to note that in the presence of such widespread metastatic disease the lungs per se remained uninvolved.
Conclusion: We describe a unique case of metastatic Ewing's sarcoma who showed rapid systemic disease progression with widespread skeletal metastases (and CNS involvement) but without any evidence of pulmonary involvement.
Keywords: Atypical; Ewing; Presentation; Sarcoma.
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