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Autopsy and Medicine
August 14/28, 2000

Case of the Month: What Killed the Patient—the Disease or the Experimental Treatment?

Larry Nichols, MD; Randy Hanzlick, MD; and the Autopsy Committee of the College of American Pathologists
Arch Intern Med. 2000;160(15):2253-2254. doi:10.1001/archinte.160.15.2253

A 38-YEAR-OLD woman underwent excision of a nodular malignant melanoma of the right scapular region (level III; Breslow depth, 1.6 mm). Right axillary lymph node dissection a month later showed metastases in 5 of 6 nodes—3 with extracapsular spread. Six months later, the patient had a dental abscess associated with a dental implant; the abscess was treated with removal of the implant and 6 days of antibiotic therapy with metronidazole and amoxicillin. The next day, the patient got a new pet dog; she already had cats. The day after acquiring the dog, the patient was enrolled in a ganglioside adjuvant vaccine study (for treatment of melanoma) and received her first dose.1,2 After receiving the vaccine, the patient developed progressive dyspnea. At first she had dyspnea only after she walked up a flight of 8 stairs, but it worsened until it occurred after only minimal effort such as blow-drying her hair.