The Kveim test in sarcoidosis

Abstract

Summary The Kveim test with a validated test-suspension was found to give an overall 71·9% positive result. A very high figure was obtained among patients with hilar or paratracheal gland involvement. Despite our enumeration of the difficulties and drawbacks inherent in Kveim testing, we find that this is a valuable test, providing one is aware of the pitfalls. Despite the finding of positive tests in conditions other than sarcoidosis, these are unlikely in practice to present a clinical problem in the differential diagnosis of suspected sarcoidosis. A microscopically positive test, therefore, remains clinically valuable. The test is also of very considerable importance in the clinical research into aetiology and pathogenesis of sarcoidosis.

Granulomatous cheilitis and a positive Kveim test

“…A Kveim test is generally specific for sarcoidosis (Sharma, 1984); however, cross-reactivity between sarcoidosis and Crohn's disease occurs , and other conditions reported by Israel and Goldstein (1971) to produce positive responses are tuberculous lymphadenitis, non-specific lymphadenitis and lymphoma. None of these are of immediate relevance in our patient unless overt manifestation of systemic disease appears in the future, as a case of granulomatous cheilitis has been reported to predate the onset of Crohn's disease by several years (Carr, 1974)-In view of the fact that the rate of Kveim reactivity is low among patients in whom the manifestation of sarcoidosis is confined to a single organ (Bradstreet, Gighero & Mitchell, 1976), and that the reactivity generally decreases sharply with the passage of time (Mikhil & Mitchell, 1970), a positive Kveim response obtained at an early stage of this disease and a negative Mantoux test, perhaps due to cutaneous anergy, strengthen the possibility that we are dealing with an atypical cutaneous sarcoidosis. Also, recognizing the limitations of Kveim test reactivity and taking into consideration the occasional spontaneous remission of this condition, we suggest S.A.Shehade and I.S.Foulds that more cases of oro-facial granulomatosis may have eluded a diagnosis of cutaneous sarcoidosis in the past.…”

Massive Splenomegaly, Pancytopenia and Haemolytic Anaemia in Sarcoidosis

“…The diagnosis of sarcoidosis in this patient was made on the basis of typical histological findings, multiple organ involvement, and exclusion of other categories of granulomatous disease [36], A negative Kveim test does not necessarily preclude this diagnosis [27,40]. Massive splenome galy as the presenting feature of sarcoidosis, although described previous ly [3,5,15,18,29,45], is unusual and poses diagnostic problems.…”

Human peripheral blood mononuclear cells: A review of recent proteomic applications

“…For example, in the 2 studies investigating the PBMCs exposure to low dose radiation [32, 33], there were seven proteins or almost half of the proposed candidates in each of the studies that overlapped between the studies exhibiting great reproducibility. Similarly, two studies investigating sepsis [18–35] and those investigating diabetes and tuberculosis‐diabetes co‐pathogenesis [11–20], also identified mutual candidates. The most promising PBMCs biomarker based on specificity and validation approaches performed, are marked with red circles in Figure 4.…”

“…focused on proteomic analysis of Kveim‐reagent (Kv) stimulation of PBMCs in patients with sarcoidosis compared to tuberculosis patients and healthy individuals [25]. Cells were ex vivo stimulated with Kv (a sarcoidosis tissue spleen commonly applied when diagnosing sarcoidosis known as a Kveim skin test) [26] and with recombinant protein compounds such as vimentin, tubulin, and alpha‐actinin‐4. Cell extracts were processed by 1‐D‐SDS‐PAGE and 2D‐DIGE, resulting in the identification of 74 sarcoidosis tissue‐specific proteins.…”

“…For example, in the 2 studies investigating the PBMCs exposure to low dose radiation [32,33], there were seven proteins or almost half of the proposed candidates in each of the studies that overlapped between the studies exhibiting great reproducibility. Similarly, two studies investigating sepsis [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] and those investigating diabetes and tuberculosisdiabetes co-pathogenesis [11][12][13][14][15][16][17][18][19][20], also identified mutual candidates.…”