Kveim-Stilzbach test

Case: 34 years old female is admitted to ICU with heart blocks. Patient has multiple previous admissions with multiple different symptoms. A plethora of workups showed mixed results. Underlying sarcoidosis is suspected but never proven. Consultant suggest Kveim-Stilzbach test. 

Answer: The Kveim-Stilzbach test is utilized in suspected cases of sarcoidosis. Its best utility lies in distinguishing sarcoidosis from otherwise indistinguishable symptoms such as in berylliosis. This is also known as Nickerson-Kveim or simply as Kveim test, named after a Norwegian pathologist who suggested the test 8 decades ago. American physician named Stilzbach modified the test with the use of spleen tissue.

The test is performed by taking a suspension from the spleen or a lymph node of a patient with a confirmed diagnosis of sarcoidosis and injecting intradermally into a patient under diagnosis. If a nodule appears within 6 weeks, a test is considered positive. To confirm further, a biopsy can be performed of the nodule to find a non-caseating granuloma. Steroids can turn test false negative. 

Said that, this test is more of academic interest as it is time and labor-consuming, may yield false negative or positive results, and may transfer infections.

#rheumatology

References:

1. Kveim MA (1941). "En ny og spesifikk kutan-reaksjon ved Boecks sarcoid. En foreløpig meddelelse". Nordisk Medicin (in Norwegian). 9: 169–172. 

2. Siltzbach LE, Ehrlich JC (1954). "The Nickerson-Kveim reaction in sarcoidosis". Am. J. Med. 16 (6): 790–803. doi:10.1016/0002-9343(54)90443-X. PMID 13158367. 

3. Williams R, Nickerson D (1935). "Skin reactions in sarcoid". Proc. Soc. Exp. Biol. Med. 33 (3): 402–405. doi:10.3181/00379727-33-8388P. 

4. Cooper, Ross G.; Harrison, Adrian P. (August 2009). "The uses and adverse effects of beryllium on health". Indian Journal of Occupational and Environmental Medicine. 13 (2): 65–76. doi:10.4103/0019-5278.55122. PMC 2847329. PMID 20386622.