The Kveim Reaction and its Bearing on the Etiology of Sarcoidosis

Author’s address: Dr. R. Kooij, Gem. Ziekenhuis, Zuidwal 83, Den Haag (The Netherlands) After the introduction of the Kveim reaction the view has gained ground that sarcoidosis is a disease sui generis, caused by a still unknown agent. As the reaction papule of a positive Kveim test is indistinguishable, macroscopically and histolog-ically, from the lesion of sarcoidosis which occurs naturally, some investigators assume that the Kveim antigen contains the hypothetical agent of sarcoidosis. Kooij et al. have many times evoked with normal tissue suspensions sarcoid reaction papules in normal people and in patients with tuberculoid leprosy. Recently we have obtained in a number of patients with sarcoidosis with a normal tissue suspension sarcoid reaction papules indistinguishable from a positive Kveim reaction. Therefore, it is concluded that the Kveim antigen does not contain the unknown agent of sarcoidosis. This has a bearing on the etiology of sarcoidosis. Sarcoidosis is considered to be a syndrome occurring in certain people who have the ability to react under certain circumstances with a sarcoid pattern of reaction to one or more agents (terrain sarcoidique).