Tissue gadolinium deposition and fibrosis mimicking nephrogenic systemic fibrosis (NSF)-subclinical nephrogenic systemic fibrosis?
Nephrogenic systemic fibrosis is a condition with significant and often debilitating cutaneous manifestations. Recent research on this disease has delineated an association between nephrogenic systemic fibrosis and exposure to magnetic resonance imaging studies using gadolinium-based contrast agents in patients with ongoing renal failure. This metal has been detected in cutaneous biopsy specimens taken from lesional skin suggesting that gadolinium provides an impetus for the deposition of circulating fibrocytes in the skin and subsequent fibrosis. We describe a hemodialysis-dependent liver transplant recipient who received a gadolinium-based contrast agent and demonstrated insoluble gadolinium deposition in a fibrotic dermis and subcutaneous septum using scanning electron microscopy/energy dispersive x-ray spectroscopy. He has yet to manifest symptoms and signs of nephrogenic systemic fibrosis 3 years after his magnetic resonance imaging study.
Boyd
Alan S
AS
Department of Medicine (Dermatology), Vanderbilt University, Nashville, Tennessee, USA. alan.boyd@Vanderbilt.edu
Sanyal
Soma
S
Abraham
Jerrold L
JL
D003287:Contrast Media / Q000009:adverse effects*; D005682:Gadolinium / Q000378:metabolism*; D019786:Gadolinium DTPA / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents; D007676:Kidney Failure, Chronic / Q000473:pathology; D016031:Liver Transplantation; D008297:Male; D008855:Microscopy, Electron, Scanning; D008875:Middle Aged; D054989:Nephrogenic Fibrosing Dermopathy / Q000139:chemically induced* / Q000473:pathology; D006435:Renal Dialysis
D003287:Contrast Media; D007166:Immunosuppressive Agents; C064925:gadodiamide; D005682:Gadolinium; D019786:Gadolinium DTPA