Severe Systemic Rash in the Treatment of Hairy Cell Leukemia with Cladribine: Case Report and Literature Review

Figures & data

Figure 1 Flow cytometric (FCM) immunophenotyping of the bone marrow. FCM indicated that the abnormal B lymphocyte population mainly expressed CD19, CD45, HLA-DR, CD22, CD20, CD103, CD99 and negative for CD25, CD117, CD56, and FMC7.

Figure 2 The change of skin rash induced by cladribine in HCL, before (A–C) and after (D–F) rescue. The diffuse, exfoliated, and itchy erythema (throughout the chest, back and limbs) gradually faded after a combination treatment with corticosteroids, immunoglobulin, ebastine, and sodium thiosulfate.

Table 1 Comparison of the Literature on Cases of Severe Rash During the Cladribine Treatment in HCL and CLL

Case	Study	Age (Years)/Gender	Primary Disease	Treatment	Skin Rash (Manifestation)	Fate	Skin Rash Treatment	Suspicious Combined Drugs
1	Grey et al,^Citation14 2000	82/F	HCL	Cladribine	Back, groin, then quickly wide, blisters (merged DIC)	Survive	Corticosteroids	Allopurinol, Imipenem, Trimethoprim-sulfamethoxazole
2	Grey et al,^Citation14 2000	67/F	HCL	Cladribine	Back to body erythema	Survive	Corticosteroids	Trimethoprim-sulfamethoxazole, Imipenem
3	Meunier et al,^Citation17 1996	N/F	HCL	Cladribine	Toxic epidermal necrolysis	Survive	Unknown	Amoxicillin or sulfonamides
4	Rossini et al,^Citation19 2004	67/M	CLL	Chlorambucil, Prednisone, Cladribine	Whole body itching, rash (erythema, blisters)	Survive	Corticosteroids	Ciprofloxacin and fluconazole as prophylaxis
5	Rossini et al,^Citation19 2004	62/M	CLL	Chlorambucil, COP, Cladribine	Erythema, blisters, ulcers, diffuse dermal necrosis	Survive	Corticosteroids	Ciprofloxacin and fluconazole as prophylaxis

Abbreviations: COP, cyclophosphamide, vincristine and prednisone; HCL, hairy cell leukemia; CLL, chronic lymphocytic leukemia; DIC, disseminated intravascular coagulation.

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