Value of Kveim Test as a Diagnostic Measure in Sarcoidosis

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IN 1941, Kveim1 published a report on a “new and specific cutaneous reaction in Boeck's sarcoid.” He observed that following the intracutaneous injection of a tissue suspension of sarcoid lymph nodes in 13 patients with active sarcoidosis, 12 developed a papule at the site of injection. Histologically, these papules resembled cutaneous sarcoidosis. No papule developed in patients with either tuberculosis or syphilis who were similarly tested.

The test is not widely used, however, due to a number of inherent difficulties. The sarcoid tissue is not easy to obtain in quantity. The suspension cannot be standardized as to its potency, and the length of time needed to interpret the test tends to lessen its practical application. Further, subsequent investigators have questioned Kveim’s opinion as to the test’s specificity. It has been claimed that dead tubercle bacilli,2 BCG vaccine,3,4 normal spleen suspension,5,6 and leukemic lymph node suspension7,8 may give a response similar to the sarcoidtissue suspension when injected into patients with sarcoidosis. Also, the test has occasionally been reported as positive in conditions other than sarcoidosis.7–9 Nevertheless, interest in the test has been maintained by other reports10–18 that tend to substantiate the usefulness of this delayed papular response in the diagnosis of sarcoidosis. The Kveim test has been employed extensively at the Cleve-land Clinic for the past three years. The present study is concerned with an evaluation of the test based upon the reactions in 88 patients. The results have proved to be of such consistent diagnostic and prognostic . . .



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