About Meir Wetzler <B>M. D.</B> Expertise Leukemia acute and chronic; from chemotherapy to transplantation. Done clinical and translational research on leukemia for the last 10 years at the Roswell Park Cancer Institute.
Question QUESTION: Dr. Wetzler,
My husband, Yon, (58 years of age) was diagnosed about 10 years ago with an indolent form of Non-Hodgkins Lymphoma - Splenic Lymphoma with Villous Lymphocytes. The oncologist who first noticed his high Lymphocytes and low Neutrophils thought it was CLL, but M.D. Anderson made the above diagnosis through a bone marrow biopsy. We have been on a watchful waiting plan, and his blood levels have remained much the same - his oncologist said he watches the red blood count the most, and that is still acceptable. His spleen is enlarged and he has night sweats, but for the most part he is healthy. He has also been under the care of a naturopath, and we have been trying to strengthen his immune system through diet. He has had a very troubling condition, however, for the past 5-6 months - an itching, burning rash which started out on his ankles and hands. At one point the blisters got very nasty (I will try to attach an image), even they have improved somewhat. A dermatologist diagnosed Dyshydrotic Eczema and put him on a course of Prednizone, which improved symptoms, but the rash promptly returned even worse than before when he stopped the Prednizone. The doctor wanted him to do it again. His oncologist felt that the rash was not associated with his lymphoma and told him he should listen to the dermatologist and take another round of Pred. His internist feels that the rash is a result of the lymphoma and agrees with us that Pred. is not a wise treatment. Yon's naturopath feels that the rash is definitely an auto-immune response. So....I know this is a lot of information, but my question for you is: do you think this rash could be from his lymphoma and, if so, do you feel that a wait and watch approach is still appropriate? We have the option of returning to M.D. Anderson for a follow-up, but we would rather continue letting his body fight this on his own without the use of Chemo. However, if this rash is any indication that his condition is getting worse, we may reconsider that approach. Any advise you can give us about this rash would be greatly appreciated. It is much improved since these pictures, but he still gets new itchy, burning bumps on his fingers.
Thank you so much,
Elizabeth IMAGE: Rash
ANSWER: Dear Elizabeth,
Did your husband ever had the rash biopsied or was the diagnosis made based on its look?
Thx, Meir.
---------- FOLLOW-UP ----------
QUESTION: Yes, he did have it biopsied early this year and it came back that it was consistent with an external cause (such as contact dermatitis), but his internist still believes that the dermatologist in our small town misdiagnosed it. He recommended going to a large teaching hospital, such as Baylor or U.T. in Houston where they see more uncommon skin conditions. We have tried to eliminate everything in our environment he may be allergic to.
Answer Dear Elizabeth,
I think that in order to decide whether the rash is related to his NHL/CLL or other causes, you should consider seeking a second opinion somewhere else. Since MD Anderson diagnosed the malignant disease, you may want to consult them again to decide which route to take next.
Thx, Meir.
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