Ann Rehabil Med.  2012 Dec;36(6):880-886.

A Case of Delayed Onset Nephrogenic Systemic Fibrosis After Gadolinium Based Contrast Injection

• Do JG
• Kim YB
• Lee DG
• Hwang JH

Abstract

Nephrogenic systemic fibrosis (NSF) is a rare fibrosing disorder of the skin and joints that occurs in patients with advanced renal insufficiency. This condition is progressive and can be seriously disabling. Gadolinium based contrast agent (GBCA) has been identified as a potential cause of this condition. A 56-years-old man in hemodialysis developed stiffness and contracture of the whole limbs eight years after frequent GBCA exposure for cervical magnetic resonance imaging. For the first time in Korea, we report late-onset nephrogenic systemic fibrosis after GBCA exposure and performed an electrophysiologic study of this condition.

Keyword

Nephrogenic systemic fibrosis; Gadolinium; Electrophysiologic study

MeSH Terms

Contracture
Extremities
Gadolinium
Humans
Joints
Korea
Magnetic Resonance Imaging
Nephrogenic Fibrosing Dermopathy
Renal Dialysis
Renal Insufficiency
Skin
Gadolinium

Figure

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  Fig. 1 Histopathologic findings of nephrogenic systemic fibrosis. (A) Dermal fibrosis with thick collagen deposition (H&E stain, ×100), (B) Increased dermal collagen of the papillary dermis and deep dermis (Masson's Trichrome stain, ×200), (C) Septal fibrosis of subcutaneous adipose tissue (H&E stain, ×100).

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  Fig. 2 Lower extremity non-contrast MRI in patient with nephrogenic systemic fibrosis (T2-weighted image). Fatty atrophic changes in both gastrocnemius medial head (arrows), high signal intensity throughout the fascia (arrowheads).

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  Fig. 3 Clinical findings of the nephrogenic systemic fibrosis patient. (A) Diffuse thickening and hyperpigmentation of skin in both hands (B) Thickening and fibrotic induration of the skin in both feet (C) Both knee flexion contracture and lack of hair on the skin (D) Both ankle plantar contracture.

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