Report
Gadolinium deposition in nephrogenic fibrosing dermopathy

https://doi.org/10.1016/j.jaad.2006.10.048Get rights and content

There is growing recognition of the association between the use of gadolinium-containing radiocontrast agents for magnetic resonance imaging and the serious dermal and systemic disease nephrogenic fibrosing dermopathy/nephrogenic systemic fibrosis (NFD/NSF). The pathogenesis of this entity remains unclear; however, our recent observations suggest a likely mechanism for the initial dermal manifestations of this gadolinium toxicity.

Section snippets

Case report

A 68-year-old white female presented to the Vanderbilt University Dermatology Clinic in June 2006 with a 3-week history of thickened skin on her extremities which began as painful soft tissue swellings and rapidly became indurated. Her past history was significant for chronic hepatitis C infection–induced hepatic failure for which she received a liver transplant in 1995. Cyclosporine therapy–induced renal failure necessitated hemodialysis in January 2006. Three weeks later she underwent an

Discussion

NFD is a recently described entity occurring almost exclusively in patients undergoing hemodialysis for end stage renal disease (ESRD); while the instance is rare, patients have developed this condition while performing peritoneal dialysis.2 Beginning as swelling of the hands and feet, the skin becomes progressively thickened with a peau d'orange appearance.5 This progression appears to proceed at a variable rate, with some patients describing rapid advancement of the indurated areas while

References (10)

There are more references available in the full text version of this article.

Cited by (344)

  • MR Imaging Safety Considerations of Gadolinium-Based Contrast Agents: Gadolinium Retention and Nephrogenic Systemic Fibrosis

    2020, Magnetic Resonance Imaging Clinics of North America
    Citation Excerpt :

    The resultant free Gd activates macrophages and circulating fibrocytes, leading to aberrant collagen deposition in connective tissues.22,56 Fibrotic changes resulting from this collagen deposition have been seen in many tissues, but contractures in affected skin and muscle tissues primarily responsible for adverse symptoms, including swelling, tightening, and thickening of the skin and loss of joint flexibility.55,56,65 NSF is extremely uncommon, with approximately 613 verified cases reported to date and limited to a patient population with significant renal impairment.66

View all citing articles on Scopus

Funding sources: None.

Conflicts of interest: None identified.

Reprints not available from the authors.

View full text