A 24-year-old female patient was diagnosed with embryonal rhabdomyosarcoma of the perineum. FDG PET/CT which was ordered for restaging showed hypermetabolic mass at the perineal region consistent with recurrence and bilateral inguinal metastatic lymph nodes. Additionally, there was left iliac lytic lesion with increased FDG uptake consistent with bone-bone marrow metastases and moderately heterogenous disseminated intense FDG accumulation in the axial skeleton suggestive of bone marrow involvement. Supported by prolonged cytopenia PET/CT findings prompted us to do a bone marrow biopsy which proved to have metastatic rhabdomyosarcoma.