The Nickerson-Kveim reaction in sarcoidosis

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.

Section: Discussionmentioning

confidence: 99%

The Kveim test in sarcoidosis

Mikhail

Mitchell

1970

“…independently. The microscopic readings were recorded as 'positive', 'equivocal' or 'negative' according to the criteria of Siltzbach & Ehrlich (1954). When possible, simultaneous intracutaneous tests were made on the *This paper has appeared in the Lancet (1969, ii, 571-573) and is reproduced by kind permission of the Editor.…”

Section: Methodsmentioning

confidence: 99%

The Kveim test in Crohn’s disease

Mitchell

Dyer

Cannon

et al. 1970

“…Three minor changes (4%) were also made (three positives changed to equivocal) but these were less likely to have been of clinical importance. The Kveim biopsy The accuracy of the Kveim reaction has been shown by Siltzbach & Ehrlich (1954) to be increased if the injection site is biopsied and subjected to full histological examination. The cellular components seen in Kveim biopsies develop progressively (Rogers & Haserick, 1954) and are shown in Fig.…”

Section: Sarcoidosismentioning

confidence: 99%

“…At 5 weeks it may be expected that sarcoid granulomata have become fully developed, whilst non-specific inflammatory changes have begun to regress. Sarcoid granulomata may persist in the fibrosing lesion and be recognizable after many months (Siltzbach & Ehrlich, 1954) but no practical benefit is to be expected by delaying biopsy beyond 5 weeks. The techniques of injection and biopsy have been described by Mitchell (1968).…”

Section: Sarcoidosismentioning

confidence: 99%

Problems in histological interpretation in sarcoidosis

Drury

1970

Summary The sarcoid granuloma has a histological structure that is similar to that seen in many other diseases. Some of its diagnostic features are negative, but an accurate diagnosis can be made from biopsy tissues if numerous, monotonously uniform granulomata are present. Histological confidence is often proportional to the number of granulomata seen in the specimen. Mediastinal lymph nodes taken at mediastinoscopy have been positive in 90% of seventy-four patients with sarcoidosis. Problems in the histological interpretation of Kveim biopsies may be due to failure to include the injection site in the biopsy, to inadequate sectioning of the specimen and to equivocal cellular reactions. Despite these difficulties, dual blind reading of sections of mediastinal lymph nodes and Kveim reaction biopsies from patients with sarcoidosis has shown that the observer variation that is likely to be of clinical significance is approximately 5% in each group.