Unusual immunologic alterations in sarcoidosis during repeated Kveim testing

A thirty-eight year old woman, suffering from lymphonodal sarcoidosis, displayed exceptionally strong, rapid skin responses to several Kveim antigens, including an autologous antigen. During the initial Kveim tests the number of plasma cells in her lymph nodes increased, and marked hypergammaglobulinemia ensued. At the same time her blood showed a profound monocytosis and reactivity in flocculation tests for syphilis and in the latex flocculation test for rheumatoid factor. On the day following the second test with the most potent Kveim antigen, her blood displayed marked eosinophilia and strong complement-fixing activity against this antigen. During prednisone treatment the eosinophil count dropped abruptly, while flocculation reactions for syphilis disappeared more gradually, simultaneously with normalization of the level of gamma globulins and regression of Kveim papules and lymph nodes to a nonpalpable state. The serum, however, retained its complement-fixing activity against the repeatedly tested Kveim antigens for a longer time. The interrelations of these unusual immunologic alterations and their connection with repeated Kveim testing are discussed.