mesna and Vasculitis

DIAGNOSIS OF RENAL INVOLVEMENT: The diagnosis of renal involvement in patients with Wegener's disease and microscopic polyangeitis is facilitated with the search for antineutrophil cytoplasmic autoantibodies (ANCA) but still requires biopsy for confirmation.. Induction should be initiated immediately, and generally leads to initial remission. Long-term treatment is then needed to reduce the risk of recurrence and relapse.. Close monitoring of ANCA levels is important in these patients. Several protocols are currently under evaluation with the aim of limiting immunosuppression toxicity.

Topics: Antibodies, Antineutrophil Cytoplasmic; Churg-Strauss Syndrome; Cyclophosphamide; Diagnosis, Differential; Humans; Immunosuppressive Agents; Mesna; Vasculitis

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.

Topics: Adult; Cyclophosphamide; Drug Therapy, Combination; Humans; Male; Mesna; Middle Aged; Prednisone; Vasculitis