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Submissions to "Patients' Stories" cannot be verified for their accuracy. They do not necessarily represent validated medical research. The reader should understand that these stories represent only the opinions of the authors and not the Hairy Cell Leukemia Research Foundation. I am a 61 year old European male recently diagnosed with HCL after years of borderline anemia. My spleen finally enlarged to the point that additional testing was indicated and microscopic blood examination revealed hairy lymphocytes. I have been afflicted with chronic seasonal allergic rhinitis since puberty. Testing reveals allergies to 90% of grass pollens, half of the tree and weed pollens, and dogs and cats. Over the past year I have been experiencing unusual itchy blisters, initially resembling insect bites, appearing 1 or 2 at a time on my feet, legs, or torso, and lasting about a week. They were initially misdiagnosed as shingles because of the intense itching. The fluid from the blisters is pale yellow and seems more syrupy than the fluid from a typical burn or friction induced blister. I wonder if these blisters might represent accumulations of abnormal lymphocytes in sufficient concentrations to alter fluid flow characteristics and restrict normal dissipation through the skin circulatory system. The condition might be initiated as an allergic reaction by an over-reactive immune system. My pretreatment white blood cell count was 16.8K/uL and white blood cell differential was 70% lymphocytes (approximately 60% normal and 40% atypical hairy cells), 16% neutrophils and 4% eosinophils. My spleen was swollen to a firm mass in the upper left quadrant of my abdomen.My treatment began with ten days of the antibiotic cephalexin (4x500mg capsules daily) to reduce the risk of infection from open blisters. No new blisters have formed for two months following this treatment. A 5-day outpatient infusion sequence of 2-chlorodeoxyadenosine (13 mg daily) commenced upon completion of the antibiotic sequence. I was given one 10 mg tablet of prochlorperazine daily at the beginning of each infusion to control nausea. I experienced no nausea. I took one 300mg allopurinol tablet daily for three weeks beginning with the first day of infusion. This was intended to aid in the urinary excretion of white cell decomposition products. I drank so much water I was generally unable to sleep more than a few hours without waking with a need to urinate. I experienced minor swelling of my feet and ankles. I monitored my oral temperature twice daily beginning a few days prior to treatment in anticipation of possible temperature rise in response to release of pyrogens from lysing white cells. My morning temperature averaged 97 degrees and my evening temperature averaged 98 degrees. I was instructed to contact the hospital if my temperature rose above 101 degrees for evaluation of the possibility of infection. My temperature remained within a degree of the pretreatment norms until Wednesday evening following the third day of infusion. That evening my temperature rose a degree per hour until it was 102 at midnight. The emergency room staff found no evidence of infection in blood and urine samples and gave me two 500 mg acetaminophen tablets. My temperature briefly dropped to 97 degrees the following morning, and 500 mg acetaminophen every six hours held it between 100 and 101 degrees for the following 3 days. I noticed the first stages of a rash on Friday evening following the last infusion. By Saturday morning it had developed into a full body allergic rash. I had experienced a less severe version of this rash once before following a root canal procedure. It had been blamed on the antibiotic amoxicillin at that time; but I had also been taking acetaminophen at the endodontist's recommendation in addition to my preferred aspirin. I discontinued taking acetaminophen and commenced taking two 25 mg diphenylhydramine hydrochloride antihistamine tablets every 4 hours. Oncology pharmacists recommended against taking aspirin or ibuprofen, and my temperature remained between 100 and 101 degrees for 2 more days without antipyretics. When my physician saw the rash on Monday morning, he prescribed a twelve
day sequence of prednisone beginning with three 20 mg tablets. I was
unable to sleep for the next 24 hours. Prednisone caused brilliant,
complex visual images whenever I closed my eyes, and the white noise of
appliance fans was converted to the music of a full orchestra with vocal
accompanyment. I discontinued the prednisone sequence; and within a day
the rash faded and my temperature dropped to 98 degrees. |