Background/Purpose: We identified leukocytoclastic vasculitis (LCV) patients seen over 10 years at our institution.  Aims included 1) define cause; 2) record lab, imaging, and ancillary tests used in evaluation; 3) tabulate Medicare reimbursement costs.

Methods: All biopsy-confirmed LCV cases from 1/1/2004 to 12/31/2014 were identified by analysis of suspected cases in Dermatopathology registry.  We analyzed pathology reports and only those cases with definite LCV on biopsy and available electronic health record (EHR) progress notes were included in this analysis.  Clinical, epidemiologic, and other variables were then extracted from EHR and costs recorded.  We calculated total lab and imaging costs, plus average costs/patient.  Additionally, we determined if Rheumatology or other consultations were performed.

Results: Mean age of LCV cohort was 53.1 years, with 161 women, 115 men.  Immunofluorescence was performed in 161/276 (58 %) biopsies.  LCV etiology was divided into 6 major categories (Table 1), with Idiopathic in 41 %; Vasculitis in 32 %; Drug-induced 10 %; Infection-related 9 %; CTD 4 %; malignancy-related 3 %.  Vasculitis or CTD accounted for 101/276 cases (Table 1).  More than 50 % of Vasculitis cases were due to HSP.  The HSP group mean age was 33 years, with 23/52 (44 %) being < 20 years old.  Surprisingly, 56 % of our HSP patients were adults.  Specific lab and imaging tests are shown in Tables 2 and 3.  Total lab costs for all patients were $36,161 or $131/patient.  Total imaging costs were $85,700 or $311/patient. Rheumatology accounted for 138/147 requested consultations (94%) at cost of $20,806.  Nine renal biopsies were performed at $10,782 cost.  Glucocorticoid therapy was used in 148/276 or 54 % cases.    

Conclusion: Our report of 276 biopsy-confirmed LCV patients seen over this 10 year period may be the largest analysis so performed.   Idiopathic (41 %) and Vasculitis (32 %) were the most common causes.   Definite Rheumatic disease (Vasculitis/CTD) was identified as cause of LCV in 36 % of patients. Within the Vasculitis group, HSP comprised more than 50 % of that subgroup, with a surprising 56 % adult-HSP.   Importantly, our study includes a unique cost analysis for lab, diagnostic imaging, consultations, and renal biopsy.  The evaluation of LCV remains clinically challenging and more costly than previously reported.