Hypocomplementaemia question - update

[Guest guest]

The facial and current lip swelling event i am currently

dealing with can be a useful tutorial for proactive

patients. It is also an example of the power of the Internet

combined with a dedicated Doc., in this case Dr. Byrd

at the Cancer Center OSU, who has done some sleuthing

for me based on information I sent him that included

pictures of my uglier than usual mug and a detailed

description of my symptoms. Again, this is Saturday and the

doc on call at OSU had to run down to give him the

message that one of his " prize " lab rats was in a bad way.

Good sleuthing begins with examining the simplest solution

based on as many basic " knowns " as possible - in this case,

a review of all my meds and supplements as requested by

in an email reply to me. I had thought of multi-drug

reactions for which I did a search but using only the recent

PCI Trial drugs - PCI, Valtrex, Allopurinol & Claritin.

Nothing showed up in the interaction between any of these. I

had stupidly ignored to review my other meds being

Tamsulosin (Flomax) & Lisinopril (Ace inhibitor to control

high blood pressure) which I had been on since '09 with no

apparent problems.

My attempts to sleuth out the cause of my ailing drifted to

the more complex explanation of systemic immune complexes

and hypocomplementaemia although I reserve a place for its

possible adjunct role in my kidney issues.

" Caveat Emptor " my friends, My guard was down on checking

these drugs individually and specifically Lisinopril for

side effects for the following reasons: My kidney doctor put

me on Lisinopril (low dose) and when I questioned her as to

the choice of Lisinopril over a host of other ACE

inhibitors, she said it was the protective factor of

Lisinopril on the kidney. Secondly, I had been on it for

some 22 months with no apparent problems although it had

been increased from 2.5mg once per day to 5mg twice daily

(still considered a low dose) after Rituxan reaction in

March caused problems in controlling my high blood pressure.

Sure enough, in the " Side Effects " warnings section of the

drug literature, it states: " A very serious allergic

reaction to this drug is rare. However ........ seek

immediate medical attention if you notice any symptoms of a

serious allergic reaction, including: rash, itching/swelling

(particularly of the face/tongue/throat), .... " The word

Angioedema was not mentioned, I had no itching, no rash and

no swelling of the tongue or throat in my defense, but in

truth, I never checked. Dr. Byrd obviously did and emailed

me indicating that Lisinopril can cause angioedema. I hopped

on Google Scholar (great research tool) and searched under

" Lisinopril and Angioedema " and the first hit was:

http://allergycases.org/2008/07/angiodema-due-to-angiotensin-converting.html

or http://tinyurl.com/62n9ek

A case history with pictures remarkably paralleling my most

recent " fat lip " event of today. Final verdict is still out

but my gratitude goes out to Byrd for helping me sort

this out.

As I write, the swelling is going down as in the previous 2

events and paralleling the case history in the link. I am

off Lisinopril and plan consulting with heart and kidney

Docs on Monday then it is off to OSU on Tues.

Hardly a dull moment in CLL land. Our problems are complex

and heterogeneous in the extreme, involving not only what

the cancer may do to us but the variety of drugs we take for

direct or ancillary reasons. It looks good on paper at this

point and we will see if Lisinopril is in fact the culprit.

I will sleep easier tonight, Thanks and the on call

docs at OSU

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