Progressive arm and leg stiffness in a patient with chronic renal impairment.
BACKGROUND
A 60-year-old white woman with a history of breast cancer, autoimmune hemolytic anemia, type 2 diabetes mellitus, peripheral vascular disease, and chronic renal insufficiency presented with stiffness in her arms and legs of 3 months' duration. She had undergone multiple MRI and magnetic resonance angiography examinations with gadolinium-containing contrast media over the last 2 years.


METHODS
Complete physical examination including thorough skin examination; laboratory examinations including CBC, urinalysis, serum creatinine, protein electrophoresis and C-reactive protein; antinuclear antibody assay; Westergren erythrocyte sedimentation rate; and an excisional skin biopsy.


METHODS
Nephrogenic systemic fibrosis (also known as nephrogenic fibrosing dermopathy).


RESULTS
Symptomatic treatment, physical therapy, and a brief trial of imatinib mesylate.
Shin
Kichul
K
Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA 02115, USA.
Granter
Scott R
SR
Coblyn
Jonathan S
JS
Gupta
Samardeep
S
D003287:Contrast Media / Q000009:adverse effects; D005260:Female; D005355:Fibrosis; D019786:Gadolinium DTPA / Q000009:adverse effects; D006801:Humans; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D012595:Scleroderma, Systemic / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D013577:Syndrome
D003287:Contrast Media; D019786:Gadolinium DTPA