Clinical and immunologic studies of disseminated BCG infection.

Eight patients with disseminated BCG infection following injection of BCG into primary melanomas have been studied. These patients developed persistent fevers beginning 9 to 20 days following BCG injection. Severe liver function abnormalities occurred in all patients and peaked approximately 20 days following BCG injection. The persistent fevers, and clinical signs and symptoms of disseminated BCG infection lasted from 7 to 22 days before subsiding. Liver function abnormalities sometimes took six months to return to normal. Evidence of granulomas in liver and bone marrow were present. The natural course of this disease did not appear to be affected by therapy with isoniazid (INH). In vitro immunologic studies revealed a severe depression of lymphocyte reactivity in five of six patients sequentially tested. Wide dissemination of BCG from the site of injection is a severe complication of BCG therapy. The clinical course of this disease and suggestions for management are described in this paper.