A Study of Bacillus Calmette-Guérin Vaccination and the Kveim Reaction

Abstract

The Kveim reaction is an immunologic phenomenon peculiar to sarcoidosis. A recent report that positive Kveim tests were obtained in healthy subjects following B.C.G. vaccination led to a study of the influence of this vaccine upon the Kveim reaction of patients who had recovered from sarcoidosis, patients with chronic sarcoidosis, and subjects with history of unsuccessful B.C.G. vaccination. No conversion or augmentation of the Kveim reaction after B.C.G. vaccination was observed. The Kveim test distinguished active from recovered sarcoidosis with considerable but incomplete accuracy and appears to be a reflection of granulomatous activity rather than of a sarcoidal diathesis. Patients recovered from sarcoidosis and those with active disease failed alike to develop and maintain sensitivity to tuberculin after B.C.G. vaccination. The immunologic defect characteristic of sarcoidosis is identifiable by the inability to develop and maintain delayed hyper-sensitivity. Evidence that this defect antedates sarcoidosis is cited, and it is suggested that the immunologic abnormaility is a prerequisite to the development of sarcoidosis.