Juvenile myelomonocytic leukemia (JMML) is a rare hematopoietic malignancy in children with incidence 1.2 per million children per year. Hereby we present a case report and brief literature review of JMML in a child, especially focused on applicability in low-middle income countries. A 3.5 years-old male was referred to our tertiary center due to pallor, enlarging abdomen and neck mass, recurrent fever and chronic diarrhea. Initial laboratory workup showed Hb 6.4 g/dl, white blood cell 315.62 x 103/uL, and platelet 17 x 103/uL. Blood smears showed 10% suspected blast, 17% myelocyte, 17% metamyelocytes, with thrombocytopenic crisis. The HbF level was 5.8%. BCR-ABL gene was tested negative. The patient was diagnosed as juvenile myelomonocytic leukemia. Considering that HSCT was not able to be done in our center and lack of financial possibilities to seek that treatment abroad, family agreed to do palliative treatment. Patient was treated with 6-mercaptopurin and subcutaneous cytarabine. Four weeks after receiving 6-MP, white blood cell count decreased to 10,6 x 103/uL and spleen size was half of the original size. Patient continued the chemotherapy until week 15, chemotherapy was stopped, but 16 weeks after the diagnosis of JMLL, he developed severe thrombocytopenia, endophthalmitis, sepsis and passed away.