The Kveim-Siltzbach skin test  is based upon studies conducted by Dr. Morten Ansgar Kveim, a Norwegian dermatologist,  and published in 1941. The test was later studied extensively and popularized by Dr. Louis Siltzbach at the Mt. Sinai Medical Center in New York City. It  is the only test that, if positive, is considered to be diagnostic of sarcoidosis. The test material, a suspension of granuloma-containing spleen, lymph node, or other tissue  from a confirmed case of sarcoidosis, is injected intradermally. A positive test is characterized by the formation of a papule at the site of injection within 4-6 weeks  which, on microscopic examination, exhibits non-necrotizing granulomas and the absence of foreign material.

The Kveim test has been reported to be positive in a mean of 78% of patients with sarcoidosis worldwide (range 54%-92%). A satisfactory test suspension will identify at least 60% of patients with active sarcoidosis and will yield no more than 1% of false positive results in individuals without sarcoidosis.  A  positive Kveim test assures a diagnosis of sarcoidosis in 97%-98% of responsive individuals.  The test material must be validated by comparison with a previously validated suspension in patients with and without sarcoidosis.

Because of the difficulties involved in preparation, standardization and validation of the test material as well as significant variation in the sensitivity and specificity of  test suspensions obtained from different sources, the need for a biopsy procedure and the wait of 4-6 weeks for a diagnosis,  the Kveim test has been largely replaced by transbronchial biopsy for the diagnosis of sarcoidosis. At the present time validated Kveim test suspensions are available for diagnostic use at very few institutions worldwide.

The Kveim-Siltzbach Test

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Kveim test - skin biopsy

Non-necrotizing granulomas

Kveim test - skin biopsy

Non-necrotizing granuloma

Kveim test - skin biopsy

Non-necrotizing granulomas