The Turkish Journal of Pediatrics 2020 , Vol 62 , Num 4
Type 4 hypersensitivity development in a case due to mifamurtide
Meral Şimşek 1 ,Erman Ataş 2 ,Emin Ümit Bağrıaçık 3 ,Armağan Günal 4 ,Bülent Ünay 5
1 Department of Pediatrics, Gülhane Faculty of Medicine, Ankara, Turkey
2 Divisions of Pediatric Hematology and Oncology, Gülhane Faculty of Medicine, Ankara, Turkey
3 Department of Immunology, Gazi University Faculty of Medicine, Ankara, Turkey
4 Department of Pathology, University of Health Sciences, Gülhane Faculty of Medicine, Ankara, Turkey
5 Divisions of Pediatric Neurology, Gülhane Faculty of Medicine, Ankara, Turkey
DOI : 10.24953/turkjped.2020.04.025 Background. This report aims to discuss the mechanism of pleural and pericardial effusion related to mifamurtide which is an immunological agent used as adjuvant chemotherapy in osteosarcoma.

Case. Mifamurtide (2 mg/m2) and European and American Osteosarcoma Studies (EURAMOS) protocol were used together intravenously after complete surgical resection. No side effects occurred except for fever after the first dose. However, pleural, pericardial effusion, and splenic nodule formation began 11 months after discontinuation of mifamurtide treatment. Pleural biopsy revealed a type 4 hypersensitivity reaction. We treated the patient with 1,5 mg per day colchicine. Pericardial effusion attacks and nodules in the spleen disappeared. The patient had a mild pleural effusion attack which has not yet repeated.

Conclusion. Mifamurtide, which activates macrophages, can also activate immunity with a stand by effect and cause a hypersensitivity reaction. Keywords : child, osteosarcoma, mifamurtide, pleural effusion, pericardial effusion, hypersensitivity

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