OCULAR SARCOIDOSIS

the world in a collaborative study carried out between 1960 and 1966." In 1962, Kveim test material was prepared at the Commonwealth Serum Laboratories from a sarcoid spleen obtained in Melbourne. This proved to give a similar pattern of response in patients with and without sarcoidosis in Melbourne," and when tested in parallel with Stiltzbach's material it produced a very similar pattern of response in a series of 125 patients, 67 of whom were suffering from sarcoidosis.· This Australian material was subsequently used in a collaborative international survey between 1966 and 1969 on 2,038 patients in 37 countries.' The pattern of response WWl very similar to that reported by Stiltzbach, and the incidence of positive reactions in patients not suffering from sarcoidosis was 1'7%. This suggested that the active factor in both the Australian and the American Kveim test material was the same. Since these results were presented in 1969, however, a number of investigators have reported .a substantially higher incidence of positive reactions in some groups of patients who do not have sarcoidosis. Thus 14 of 23 patients with Crohn's disease tested by Mitchell in London," and 13 of 20 patients with the same disease tested by Karlish in Reading," gave positive Kveim reactions when tested with the Australian test material. Previously, another test material from an English source WWl reported to give positive reactions in a considerable per-centage of patients with Crohn's disease. Furthermore, Mitchell using the Australian material and this English material in the same patients simultaneously showed that 14 of 23 patients with Crohn's disease gave a positive reaction to both test materials." On the other hand, Stiltzbach failed to observe any positive reaction In 16 patients with Crohn's disease in New York when tested simultaneously with his own test material and with test material derived from the same English source as that used by Mltchell.v Positive reactions to the Australian test material have also been reported in a significant number of patients suffering from diseases other than sarcoidosis, including chronic lymphatic leukremla and enlarged lymph nodes due to other causes." The reason for this is not dear, especially as the pattern of positive responses in sarcoidosis remains unchanged. At the moment, however, .a positive result to a Kveim test with this material In a patient with enlarged lymph nodes should not be taken as mdtcattng that these are due to sarcoidosis.