A second uneventful pregnancy of a young mother resulted in the vaginal delivery of a 2.5kg female baby at full-term. She was delivered in Najran at a primary care hospital. Our patient presented with abdominal distention at time of birth. On examination, she had no signs of jaundice or pallor. Her vital signs were normal. Her abdomen was enlarged and measured at 39cm. Upon palpating the abdomen, hepatic border was palpable 8cm below the costal margin. The abdomen was non-tender and soft in consistency. Other abdominal organs were not palpable. An Ultrasound Abdomen was performed showing heterogeneous increased parenchymal echogenicity of the liver with moderate enlargement, no focal hepatic lesion identified. Right adrenal mass lesion was identified for further evaluation. A CT Chest Abdomen Pelvis was also performed revealing hepatomegaly with diffuse heterogeneous infiltrative lesion with bilateral suprarenal homogeneous soft tissue lesions likely representing adrenal hemorrhage [figure 1]. She was initially admitted at our hospital as an elective case of right sided hematoma for further investigation. During her hospitalization, she developed frequent episodes of hypoglycemia down to 2mmol/L. A liver biopsy was performed, the sample consisted of three irregular-shaped pink-tan soft tissue biopsies, measuring in aggregate 1x0.3x0.2 cm. The sample confirmed metastatic neuroblastoma [figure 2]. Immunohistochemistry showed positive for chromogranin and synaptophysin [figure 3]. Staining for TdT, CD99, CK AND WT-1 were negative. A sample was sent for Bone Marrow Biopsy that showed no evidence of metastatic involvement. A chromosomal analysis revealed no change in copy number of MYCN. Newborn metabolic screen was unremarkable.