Nonspecific immunotherapy with BCG has become an established modality of treatment in malignant melanoma since Math+ introduced it in 1962 [4,5]. Local and nonspecific complications are common and well documented. Cases of disseminated BCG infection, however, are rare and, if unrecognized and untreated, may eventually lead to a fatal outcome [6].
In October 1972 a male patient of 48 years of age, known to be suffering from metastatic malignant melanoma of the skin of the upper trunk, was admitted to the Department of Oncology for immunotherapy, after radical surgery, radiotherapy, and chemotherapy had failed to control progress of the disease.
On physical examination, apart from the abovementioned cutaneous lesions, there were no abnormal findings: liver, brain scan, and chest X-ray were all within normal limits. Delayed-hypersensitivity skin tests, ineluding PPD (up to 250 TU), Candida albicans (up to 1 : 1000), and SK-SD (up to 10/40 units), did not elicit a positive reaction.
Treatment was started with intratumoral injection of 0.1 cm 3 freeze-dried vaccine (Glaxo), containing approximately 108 live organisms per millilitre, at weekly intervals. Fever was noted after each injection, reaching a maximum of 40 ยฐ C. The fever persisted for 4 -5 days after each injection, and subsequently remained at a level of 38 ยฐ C for a period of 1 month. During this time all investigations failed to reveal a definite cause of this febrile state.
Therapy with INH (at a dose of 300 rag/day) was begun, and shortly after this the temperature returned to normal levels.
Six weeks after the initiation of treatment with BCG, delayed-hypersensitivity skin tests were repeated with the same three antigens, and revealed a strongly positive reaction to PPD and Candida extract (Fig. 1).