Generalized Cutaneous Reaction Associated with the Intratumor Injection of BCG

BCG was injected into multiple intracutaneous tumor nodules in a patient with malignant melanoma. The melanoma nodules completely regressed, and the patient has remained in remission. Following repeated systemic and intratumor injections of BCG, she developed a marked generalized cutaneous reaction with subcutaneous granulomas. These responded to steroid and isoniazid therapy. The pathophysiology of this reaction and guidelines for immunotherapy with BCG are discussed.