Gadolinium-associated nephrogenic systemic fibrosis in a 9-year-old boy

We describe a 9-year-old boy on chronic hemodialysis who presented with hyperpigmented, tightly bound-down, indurated plaques of his bilateral lower extremities. Pertinent history included a recent series of magnetic resonance imaging tests utilizing gadolinium-based contrast media. Histopathology showed widened septae with increased fibroblasts and collagen in the subcutis consistent with nephrogenic systemic fibrosis. Nephrogenic systemic fibrosis is a unique fibrosing disorder characterized by skin thickening of the extremities and trunk, resembling that seen in systemic sclerosis. The majority of cases have been reported in dialysis or renal transplant patients. This case of nephrogenic systemic fibrosis in a young child is presented to raise awareness in the pediatric community of nephrogenic systemic fibrosis and of gadolinium contrast being a possible trigger.