title: Nephrogenic systemic fibrosis associated with gadolinium use.
abstract: Nephrogenic systemic fibrosis (NSF) is an idiopathic, progressive, systemic fibrosis that occurs in patients with renal diseases. Recently, gadolinium-containing contrast (Gd-contrast) has become a suspected causal factor for NFS. This report discusses two female patients with end-stage renal disease, aged 70 and 51 years, respectively, who developed histologically proven NSF after exposure to Gd-contrast. Clinically, both patients were characterized by fibrosis and induration of skin and muscle mainly in the limbs with joint contracture. In the first case, NSF developed gradually after undergoing evaluation by Gd-contrast magnetic resonance imaging (MRI) and subsequent surgery for her urothelial carcinoma. In the second patient, NSF developed after undergoing evaluation by Gd-contrast MRI for her right shoulder bursitis with calcification, and the conditions of NSF continued to worsen after the surgical treatment of this right shoulder lesion. Although the role of Gd-contrast in NSF is still not well known, the correlation in our cases strongly suggests that it should be used with cautioned in patients with end-stage renal disease. Both of our patients underwent surgery before or during the development of NSF, indicating that the surgical procedure may be a contributing factor.
authors.affiliation: Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Chi-Chao
authors.initials: CC
authors.lastname: Chao
authors.forename: Chih-Chao
authors.initials: CC
authors.lastname: Yang
authors.forename: Cheng-Hsiang
authors.initials: CH
authors.lastname: Hsiao
authors.forename: Ming-Kai
authors.initials: MK
authors.lastname: Pan
authors.forename: Chin-Hsuan
authors.initials: CH
authors.lastname: Lin
authors.forename: Sung-Tsang
authors.initials: ST
authors.lastname: Hsieh
mesh_terms: D000368:Aged; D003287:Contrast Media / Q000009:adverse effects*; D005260:Female; D005355:Fibrosis / Q000139:chemically induced; D019786:Gadolinium DTPA / Q000009:adverse effects*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000150:complications*
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA