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Mesna side effects which imitate vasculitis
E Reinhold-Keller1, J Mohr, E Christophers
1Abteilung klinische Rheumatologie, Medizinischen Universität zu Lübeck.
Abstract:
Mesna (sodium-2-mercaptoethansulfonate) is used in the prophylaxis of cyclophosphamide (CYC)-induced hemorrhagic cystitis. Four patients being treated with "low dose" CYC and prednisone for vasculitis developed severe side effects to Mesna. Fever, arthralgia, myalgia, tachycardia, electrocardiogram changes consistent with perimyocarditis, erythroderma, bullous skin and mucous membrane lesions, and abdominal complaints with profuse diarrhea were noted approximately 3 weeks after the initiation of therapy for CYC-induced leukopenia and a conservatively reduced prednisone dosage. Positive reexposure tests confirmed the association to Mesna use, and hypersensitivity skin tests demonstrated a delayed hypersensitivity reaction.
Insights
Mesna (sodium-2-mercaptoethansulfonate) can cause severe hypersensitivity reactions, including skin and cardiac issues, in patients treated with cyclophosphamide (CYC). This study highlights the potential for Mesna to induce delayed hypersensitivity, necessitating careful patient monitoring.
Area of Science:
- Pharmacology
- Toxicology
- Immunology
Background:
- Mesna (sodium-2-mercaptoethansulfonate) is a standard prophylactic agent against cyclophosphamide (CYC)-induced hemorrhagic cystitis.
- Cyclophosphamide is an alkylating agent used in treating various autoimmune diseases and cancers.
Observation:
- Four patients receiving low-dose CYC and prednisone for vasculitis developed severe adverse events approximately three weeks after initiating Mesna therapy.
- Symptoms included fever, arthralgia, myalgia, tachycardia, electrocardiogram changes indicative of perimyocarditis, erythroderma, and bullous lesions on skin and mucous membranes.
Findings:
- Positive re-exposure tests confirmed Mesna as the causative agent for the observed severe side effects.
- Hypersensitivity skin tests revealed a delayed hypersensitivity reaction to Mesna.
Implications:
- This case series suggests that Mesna can induce severe, delayed hypersensitivity reactions, extending beyond typical urinary tract protection.
- Clinicians should be vigilant for systemic hypersensitivity reactions to Mesna, particularly in patients with autoimmune conditions on long-term therapy.
- Further investigation into the immunological mechanisms of Mesna hypersensitivity is warranted.