Patients with
renal failure sometimes develop
nephrogenic systemic fibrosis (NSF) following administration of
gadolinium, and a few cases have been reported in Japan. There is no definitive cure; the disease is progressive and can be fulminant. We report a case of a 54-year-old woman with multiple pathologies, including
lupus nephritis at 23 years,
peritoneal dialysis at 34 years,
hepatocellular carcinoma at 47 years, a switch to
hemodialysis, partial
hepatectomy and
axillo-femoral bypass grafting for severe
aortic stenosis at 52 years, as well as multiple MRI exposures. One month after the last MRI including an intravenous
gadolinium contrast agent (
Magnevist), she developed thickening of the skin with brownish
hyperpigmentation on the lower legs spreading later to all extremities, which limited joint movement and resulted in
contractures. She was treated with low-dose
prednisolone and
cyclosporine, however, she remains at present unable to walk or extend the joints of the upper and lower extremities and needs
analgesia for sharp
pain in the thickened skin. Various factors including multiple exposures to
gadolinium-containing MRI
contrast agents, inflammatory burden, and hepatic disease might have played a role in the development of NSF. This is the case of a Japanese patient with gadopenate-dimeglumine (
Magnevist) related NSF. Regardless of ethnicity and the type of
contrast agent, we should be aware of the potential development of NSF in patients with
renal failure.