Prolonged fever after pleural instillation of Corynebacterium parvum (Coparvax).

CASE I A 70 year old woman presented with a pleural effusion containing undifferentiated carcinoma cells. Biopsy of an enlarged cervical gland yielded material with the histological features of adenocarcinoma. She had a previous history of systemic lupus erythematosus and seropositive arthritis. Corynebacterium parvum (7 mg in 20 ml normal saline) was instilled into the pleural cavity after aspiration to dryness. On the evening of the procedure her temperature rose to 38 5°C and this was associated with nausea and tachycardia. The fever continued unabated for the next 10 days and was associated with a moderate rise in peripheral white blood count (maximum 16 x 109/1, 83% neutrophils, on day six). Bacterial investigations, including sputum, blood, urine, and throat swab cultures, all gave negative results. The fever eventually settled on day 10 but she continued to experience night sweats for some time afterwards. So far, several months after the instillation, no further accumulation of her effusion has occurred. Despite the appearance of secondary deposits in her liver, the primary site of this woman's primary tumour remains elusive.