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Severe Complications of Intralesional BCG Therapy in an Unsensitized Patient: Case Report and Clinical Implications

Severe Complications of Intralesional BCG Therapy in an Unsensitized Patient: Case Report and... Abstract • Since the introduction of BCG intralesional immunotherapy for melanoma, severe complications, including death, have been reported after treatment in hypersensitized individuals. This is a case report of BCG dissemination with ulceration, skin necrosis, lymphadenitis, and abscess formation following the first intralesional injection of a minimal dose of BCG in a PPD-negative patient. The case demonstrates that severe complications can occur in patients who are not hypersensitized, anergic, or debilitated or who have been treated multiple times. This patient's complication further suggests that migration of BCG after intralesional therapy may play a role in the regression of uninjected nodules seen in some patients. (Arch Surg 113:893-896, 1978) References 1. Levy NL, Seigler HF, Shingleton WW: A multiphase immunotherapy regimen for human melanoma: Clinical and laboratory results . Cancer 34( (suppl) ):1548-1557, 1974.Crossref 2. Morton D, Eilber FR, Holmes EC, et al: BCG immunotherapy of malignant melanoma: Summary of a seven-year experience . Ann Surg 180:635-643, 1974.Crossref 3. Nathanson L: Regression of intradermal malignant melanoma after intralesional injection of Mycobacterium bovis strain BCG . Cancer Chemother Rep 56:659-665, 1972. 4. Palmer CE, Edwards LB: Tuberculin test in retrospect and prospect . Arch Environ Health 15:792-808, 1967.Crossref 5. Seigler HF, Shingleton WW, Metzgar RS, et al: Nonspecific and specific immunotherapy in patients with melanoma . Surgery 72:162-174, 1972. 6. Bast R, Zbar B, Borsos T: BCG and cancer . N Engl J Med 290:1413-1420, 1458-1469, 1974.Crossref 7. McKahnn C, Gunnarsson A: Immunotherapy of melanoma with BCG: A fatality following intralesional injection , in Neoplasm Immunity: BCG Vaccination . Evanston, Ill, Schori Press, 1974, vol 1, pp 31-44. 8. Rosenberg EB, Schwartzman RJ: Systemic infection following BCG therapy . Arch Intern Med 134:769-770, 1974.Crossref 9. Sparks FC, Silverstein MJ, Hunt JS, et al: Complications of BCG immunotherapy with cancer . N Engl J Med 289:827-830, 1973.Crossref 10. Spitler L, Wybran J, Lieberman R, et al: Results of intralesional BCG therapy in malignant melanoma: Clinical and immunologic evaluation and complication , in Neoplasm Immunity: BCG Vaccination . Evanston, Ill, Shori Press, 1974, vol 1, pp 45-58. 11. Cohen MH, Felix E, Jessup J, et al: Treatment of metastatic melanoma by intralesional injection of BCG, organic chemicals and C. parvum , in Crispen R (ed): Neoplasm Immunity: Mechanisms, Proceedings of a Chicago Symposium, 1975 . Chicago, ITR 1976. 12. Pinsky C, Hirshaut Y, Oettgen H: Treatment of malignant melanoma by intratumoral injection of BCG . Proc Am Assoc Cancer Res 13:21, 1972. 13. Furcolow M, Hewell B, Nelson W, et al: Quantitative studies of the tuberculin reaction . Public Health Rep 561:1082-1100, 1941.Crossref 14. Blattner RJ: Generalized BCG infection . J Pediatr 65:311-314, 1964.Crossref 15. Hanna MG, Zbar B, Rapp HJ: Histopathology of tumor regression after intralesional injection of Mycobacterium bovis: II. Comparative effects of vaccinia virus, oxazolone, and turpentine . J Natl Cancer Inst 48:1697-1703, 1972. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Severe Complications of Intralesional BCG Therapy in an Unsensitized Patient: Case Report and Clinical Implications

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Publisher
American Medical Association
Copyright
Copyright © 1978 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1978.01370190115025
Publisher site
See Article on Publisher Site

Abstract

Abstract • Since the introduction of BCG intralesional immunotherapy for melanoma, severe complications, including death, have been reported after treatment in hypersensitized individuals. This is a case report of BCG dissemination with ulceration, skin necrosis, lymphadenitis, and abscess formation following the first intralesional injection of a minimal dose of BCG in a PPD-negative patient. The case demonstrates that severe complications can occur in patients who are not hypersensitized, anergic, or debilitated or who have been treated multiple times. This patient's complication further suggests that migration of BCG after intralesional therapy may play a role in the regression of uninjected nodules seen in some patients. (Arch Surg 113:893-896, 1978) References 1. Levy NL, Seigler HF, Shingleton WW: A multiphase immunotherapy regimen for human melanoma: Clinical and laboratory results . Cancer 34( (suppl) ):1548-1557, 1974.Crossref 2. Morton D, Eilber FR, Holmes EC, et al: BCG immunotherapy of malignant melanoma: Summary of a seven-year experience . Ann Surg 180:635-643, 1974.Crossref 3. Nathanson L: Regression of intradermal malignant melanoma after intralesional injection of Mycobacterium bovis strain BCG . Cancer Chemother Rep 56:659-665, 1972. 4. Palmer CE, Edwards LB: Tuberculin test in retrospect and prospect . Arch Environ Health 15:792-808, 1967.Crossref 5. Seigler HF, Shingleton WW, Metzgar RS, et al: Nonspecific and specific immunotherapy in patients with melanoma . Surgery 72:162-174, 1972. 6. Bast R, Zbar B, Borsos T: BCG and cancer . N Engl J Med 290:1413-1420, 1458-1469, 1974.Crossref 7. McKahnn C, Gunnarsson A: Immunotherapy of melanoma with BCG: A fatality following intralesional injection , in Neoplasm Immunity: BCG Vaccination . Evanston, Ill, Schori Press, 1974, vol 1, pp 31-44. 8. Rosenberg EB, Schwartzman RJ: Systemic infection following BCG therapy . Arch Intern Med 134:769-770, 1974.Crossref 9. Sparks FC, Silverstein MJ, Hunt JS, et al: Complications of BCG immunotherapy with cancer . N Engl J Med 289:827-830, 1973.Crossref 10. Spitler L, Wybran J, Lieberman R, et al: Results of intralesional BCG therapy in malignant melanoma: Clinical and immunologic evaluation and complication , in Neoplasm Immunity: BCG Vaccination . Evanston, Ill, Shori Press, 1974, vol 1, pp 45-58. 11. Cohen MH, Felix E, Jessup J, et al: Treatment of metastatic melanoma by intralesional injection of BCG, organic chemicals and C. parvum , in Crispen R (ed): Neoplasm Immunity: Mechanisms, Proceedings of a Chicago Symposium, 1975 . Chicago, ITR 1976. 12. Pinsky C, Hirshaut Y, Oettgen H: Treatment of malignant melanoma by intratumoral injection of BCG . Proc Am Assoc Cancer Res 13:21, 1972. 13. Furcolow M, Hewell B, Nelson W, et al: Quantitative studies of the tuberculin reaction . Public Health Rep 561:1082-1100, 1941.Crossref 14. Blattner RJ: Generalized BCG infection . J Pediatr 65:311-314, 1964.Crossref 15. Hanna MG, Zbar B, Rapp HJ: Histopathology of tumor regression after intralesional injection of Mycobacterium bovis: II. Comparative effects of vaccinia virus, oxazolone, and turpentine . J Natl Cancer Inst 48:1697-1703, 1972.

Journal

Archives of SurgeryAmerican Medical Association

Published: Jul 1, 1978

References