title: Nephrogenic Systemic Fibrosis Manifesting a Decade After Exposure to Gadolinium.
abstract: OBJECTIVE
  Nephrogenic systemic fibrosis (NSF) is a fibrosing skin disorder that develops in patients with kidney failure and has been linked to exposure to gadolinium-containing contrast agents. The time between exposure to gadolinium and the initial presentation of NSF is typically weeks to months but has been documented to be as long as 3½ years. We report a case of NSF developing 10 years after exposure to gadolinium.
  
  
  METHODS
  A long-term hemodialysis patient was exposed to gadolinium several times between 1998 and 2004 during magnetic resonance angiography of his abdominal vessels and arteriovenous fistula. In 2014, he was seen at our clinic with new dermal papules and plaques. Biopsy of affected skin showed thickening of collagen, CD34+ spindle cells, and increased mucin in the dermis, supporting the diagnosis of NSF.
  
  
  CONCLUSIONS
  The clinical history and histopathological features of this case support the diagnosis of NSF 10 years after exposure to gadolinium. Although the use of gadolinium contrast agents in patients with kidney failure has markedly decreased, patients with exposure to gadolinium years to decades previously may manifest the disease.
authors.affiliation: Department of Dermatology, University of Virginia School of Medicine, Charlottesville.
authors.forename: Krista N
authors.initials: KN
authors.lastname: Larson
authors.affiliation: Department of Dermatology, University of Virginia School of Medicine, Charlottesville.
authors.forename: Amy L
authors.initials: AL
authors.lastname: Gagnon
authors.affiliation: Department of Dermatopathology, University of Virginia School of Medicine, Charlottesville.
authors.forename: Melissa D
authors.initials: MD
authors.lastname: Darling
authors.affiliation: Department of Dermatopathology, University of Virginia School of Medicine, Charlottesville.
authors.forename: James W
authors.initials: JW
authors.lastname: Patterson
authors.affiliation: Department of Dermatology, University of Virginia School of Medicine, Charlottesville.
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Cropley
mesh_terms: D000792:Angiography / Q000379:methods; D001706:Biopsy; D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects*; D005682:Gadolinium / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D054989:Nephrogenic Fibrosing Dermopathy / Q000139:chemically induced* / Q000175:diagnosis / Q000473:pathology; D006435:Renal Dialysis; D013997:Time Factors
chemical_list: D003287:Contrast Media; D005682:Gadolinium