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The Nickerson-Kveim reaction in sarcoidosis

The American Journal of Medicine
Publication Date
DOI: 10.1016/0002-9343(54)90443-x
  • Biology
  • Medicine


Abstract The Nickerson-Kveim cutaneous test for sarcoidosis, as employed in our studies, consisted of the intradermal injection of a heat-sterilized suspension of human sarcoid tissue and subsequent histologic examination of the site of injection. In a positive reaction a sarcoid-like granuloma is produced at the injection site after some weeks. The test was given to 200 patients. Fifty-eight patients had sarcoidosis, the diagnosis being confirmed by biopsy of an involved organ or tissue. Eighty were sarcoidosis suspects; of these, thirty-three were strong suspects. Fifty-four patients had diseases other than sarcoidosis, and they served as “controls.” Eight patients had unclassified granulomatous disorders. Results of this study disclose that a high percentage of the biopsy-confirmed group and of the group containing strong suspects gave histologically positive responses to the test—86 per cent of the former and 85 per cent of the latter. Two patients in the “control” group had positive responses to the test, an incidence of 4 per cent of false positive reactions. Biopsy of the injection site was considered an obligatory part of the intracutaneous test in this study. The biopsies were usually carried out four to six weeks after the sarcoid suspensions were injected. In all, 571 biopsies of Nickerson-Kveim test areas were performed. In this study a Nickerson-Kveim result was called positive only if a histologically characteristic sarcoid-like granuloma could be demonstrated at the site of injection after a suitable interval. Foreign body reactions and non-specific reactions sometimes interfered with the microscopic reading of the test. Suspensions of normal lymph node and normal spleen did not evoke a positive reaction in patients with sarcoidosis who did respond to a suspension of sarcoid tissue. The Nickerson-Kveim intracutaneous test is a useful confirmatory tool in the diagnosis of sarcoidosis. The test is of aid especially when tissues from involved organs are not readily accessible to biopsy. The test has growing applicability in differentiating granulomatous conditions. In such instances the result of the Nickerson-Kveim reaction can also be a determining factor in the choice of proper therapy.

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