Diagnostic concordance in cutaneous vasculitis: A retrospective study from a fourth-level hospital in Colombia

Internal use Cutaneous vasculitis represents a diagnostic challenge due to its varied clinical presentations and potential overlap with other dermatological conditions. The objective of our study was to assess the concordance between clinical suspicion and histopathological findings, characterize histopathological subtypes, and analyze inflammatory markers in cutaneous vasculitis. This study analyzed patients who underwent skin biopsy. Patients were categorized based on clinical suspicion of vasculitis by dermatologists or rheumatologists. Categorical variables are reported as frequencies and percentages. Diagnostic concordance was assessed using Cohen's kappa coefficient. Differences in inflammatory markers, including erythrocyte sedimentation rate and C-reactive protein levels, were evaluated using a non-parametric test. All statical analyses were conduced using R. Of the total cohort, 80 patients presented with clinical suspicion of vasculitis, and 20 suspected with other diagnostic impressions were biopsied (Table 1). There was no significant difference in general inflammatory biomarkers between the group with biopsyconfirmed vasculitis and the group with biopsy-negative results (pvalues of 0.068 and 0.929 for erythrocyte sedimentation rate and C-reactive protein, respectively). This study highlights limited diagnostic concordance between clinical impression and biopsy-confirmed vasculitis, emphasizing the need for improved diagnostic pathways in dermatology and rheumatology practices. Small-vessel vasculitis predominated among confirmed cases. General inflammatory biomarkers do not seem to play an important role in the paraclinical assessment of the condition. Diagnostic concordance in cutaneous vasculitis: A retrospective study from a fourth-level hospital in Colombia Deiner-Yivelson Muñoz-Delgado1,Julian-Esteban Barahona-Correa2,3, Isabel-Cristina Cuellar-Ríos4, Martin AlonsoRondon5, Santiago Bernal-Macías1,6 Daniel-Gerardo Fernández-Ávila1,6. 1. Departamento de medicina interna, Pontificia Universidad Javeriana, 2. Departamento de medicina interna, Hospital Universitario San Ignacio, 3. División de reumatología, Pontificia Universidad Javeriana, 4. Departamento de dermatología, Hospital Universitario San Ignacio,5. Departamento de epidemiología y estadística, Pontificia Universidad Javeriana, 6. División de reumatología, Hospital Universitario San Ignacio, Bogotá, Colombia. Reference 1: T. Prasad et al. "Clinicohistopathological study of cutaneous vasculitis." Journal of Medical Science and Clinical Research (2018). Reference 2: Marvisi, Chiara, et al. "What to know about biopsy sampling and pathology in vasculitis?." Current Rheumatology Reports 24.9 (2022): 279-291. Disclosure of Interest: None Declared Keywords: Cutaneous vasculitis, Diagnostic concordance, Skin biopsy, Rheumatology, Dermatology, Histopathology, Smallvessel vasculitis Group Patients with Clinical suspicion n = 80 Patients without clinical suspicion n = 20 Total Diagnostic concordance (%) Cohen's Kappa coefficient Interpretation Clinically suspected vasculitis confirmed by biopsy Clinically suspected cases with biopsy results inconsiste nt with vasculitis Biopsyconfirme d vasculiti s without clinical suspicio n Neither clinical suspicion nor biopsy findings indicative of vasculitis Dermatol ogy patients (n = 91) 52 21 18 091 57.1 -0.27 95% CI: - 0.35 to - 0.19 No agreement Rheumato logy patients (n = 9) 5 3 1 0 9 55.6 -0.20 95% CI: - 0.52 to 0.12 No agreement to poor agreement Total patients (N = 100) 57 24 19 0100 57.0 -0.22 95% CI: - 0.34 to - 0.098 No agreement Table 2: Diagnostic concordance between clinical suspicion and biopsy findings in dermatology and rheumatology patients Figure 1: Autoimmune comorbidities at the time of biopsy Variable n=80 (%) N=20(%) Age in years (SD) 49.08 (18.01) 49.3 (17.8) Sex - female n (%) 46 (57,5%) 10 (50%) Associated symptoms Constitutional symptoms 24 (30%) 4 (20%) Gastrointestinal symptoms 19 (23,7%) 6 (30%) History of chronic diseases HTA 20 (25%) 4 (20%) Heart disease 7 (8,75%) 4 (20%) Medications Painkillers 26 (32,5%) 6 (30%) Immunosuppressants 28 (35%) 6 (30%) Biopsied lesión Plate 49 (61,2%) 5 (25%) Taint 32 (40%) 8 (40%) Papule 24 (30%) 6 (30%) Type of vasculitis according to skin biopsy Leucocytoclastic 38 (47,5%) 6 (30%) Neutrophilic 9 (11,2%) 5 (25%) Urticarial 5 (6,2%) 6 (30%) Others 6 (7,5%) 3 (15%) Immunofluorescence positivity C 3 33 (41,2%) 5 (25%) Fibrinogen 25 (31,2%) 3 (15%) IgM 21 (26,2%) 5 (25%) C 1q 10 (12,5%) 2 (10%) IgA 10 (12,5%) 3 (15%) IgG 5 (6,2%) 2 (10%) Table 1: Demographic characteristics, clinical variables of patients with clinical suspicion or diagnosis of vasculitis Methods An important occurrence of autoimmune comorbidities in biopsyconfirmed cases reflects the systemic nature of many vasculitis subtypes (Figure 1). Concordance analysis revealed no agreement between clinical suspicion and histopathological confirmation for dermatologists (κ= -0.27, 95% CI: -0.35 to -0.19) and null-to-poor agreement for rheumatologists (κ= -0.20, 95%CI: -0.52 to 0.12) (Table 2). SLE: Systemic lupus erythematosus, RA: Rheumatoid arthritis Background /Objectives Results Conclusions