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Hairy cell leukemia is a rare chronic lymphoproliferative disorder characterized by presence of characteristic hairy cell in peripheral blood or bone marrow, pancytopenia and splenomegaly. The diagnosis of hairy cell is usually based on presence of characteristic clinical features, morphology and immunophenotypic studies by flow cytometry. Hairy cell leukemia can sometime present with unusual characteristic clinical features therefore it is important to recognize these atypical presentations and associations in order to correctly diagnose and differentiate from other lymphoproliferative disorders