Acute promyelocytic leukemia (APL) is associated with severe hemorrhagic coagulopathy induced by the release of procoagulant, plasminogen, and protease from leukemic cells. The case described in this report is of a 15-year-old male who unexpectedly died due to a cerebral hemorrhage caused by underlying APL within 12 h after presentation. This case suggests that underlying APL should be considered as a differential diagnosis when sudden death occurs with a fatal spontaneous hemorrhage, although it is rare.