title: Severe allergic reactions to thiol-based cytoprotective agents mesna and amifostine in a child with a supratentorial primitive neuroectodermal tumor.
abstract: Both 2-mercaptoethane sulfonate sodium (mesna) and amifostine's active metabolite WR-1065 are thiol-based cytoprotective agents that are critical components of high-dose chemotherapy regimens used to treat various cancers in both adults and children. This case report describes a patient with a supratentorial primitive neuroectodermal tumor who developed severe drug reactions to both mesna and amifostine/WR-1065, suggesting that the thiol component of these agents triggered the adverse reactions. This report highlights the clinical presentation of drug-induced hypersensitivity syndrome in the context of pediatric oncology and the supportive care measures that, if implemented rapidly, may diminish the reaction severity and allow successful completion of chemotherapy.
authors.affiliation: Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Dorris
authors.forename: Maryam
authors.initials: M
authors.lastname: Fouladi
authors.forename: Stella M
authors.initials: SM
authors.lastname: Davies
authors.forename: John P
authors.initials: JP
authors.lastname: Perentesis
authors.forename: Julia M
authors.initials: JM
authors.lastname: Lawrence
authors.forename: Lionel M L
authors.initials: LM
authors.lastname: Chow
authors.forename: Amal
authors.initials: A
authors.lastname: Assa'ad
authors.forename: Burcin
authors.initials: B
authors.lastname: Uygungil
authors.forename: Sonata
authors.initials: S
authors.lastname: Jodele
mesh_terms: D004999:Amifostine / Q000009:adverse effects*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects; D002648:Child; D003131:Combined Modality Therapy; D016371:Cranial Irradiation; D004342:Drug Hypersensitivity / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D008297:Male; D015080:Mesna / Q000009:adverse effects*; D018242:Neuroectodermal Tumors, Primitive / Q000188:drug therapy*; D011379:Prognosis; D020011:Protective Agents / Q000009:adverse effects; D013438:Sulfhydryl Compounds / Q000009:adverse effects; D015173:Supratentorial Neoplasms / Q000188:drug therapy*
chemical_list: D020011:Protective Agents; D013438:Sulfhydryl Compounds; D004999:Amifostine; D015080:Mesna