BILATERAL ADRENAL HEMORRHAGE AND ADRENAL INSUFFICIENCY IN A PATIENT WITH LYMPHOMATOUS ADRENAL INFILTRATION FOLLOWING ADMINISTRATION OF A FUSION TOXIN (DAB(486)INTERLEUKIN-2)

DAB(486)IL-2 is a novel fusion toxin in which the ADP-ribosyltransfera se and membrane-translocating domains of diphtheria toxin have been co mbined with the interleukin-2 (IL-2) gene, creating a recombinant prot ein capable of selectively intoxicating cells bearing the high-affinit y IL-2 receptor. Clinical activity has been documented in Hodgkin dise ase and the non-Hodgkin lymphomas; toxicities have been minimal and in clude mild hepatic transaminitis, proteinurea, and hypersensitivity re actions. In this report, a patient with tumor-stage cutaneous T-cell l ymphoma developed clinical adrenal failure with bilateral adrenal hemo rrhage and necrosis 7 weeks after completing a 5-day course of treatme nt with DAB(486)IL-2. The relationship of fusion toxin therapy to the development of this unusual toxicity is discussed.