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Nephrogenic Systemic Fibrosis Manifesting a Decade After Exposure to Gadolinium
Krista N Larson1, Amy L Gagnon1, Melissa D Darling2
1Department of Dermatology, University of Virginia School of Medicine, Charlottesville.
JAMA Dermatology
|May 29, 2015
Summary
Nephrogenic systemic fibrosis (NSF) can manifest up to 10 years after gadolinium contrast exposure in kidney failure patients. This case highlights the delayed onset of NSF, emphasizing long-term patient monitoring for fibrotic skin disorders.
Area of Science:
- Nephrology
- Dermatology
- Radiology
Background:
- Nephrogenic systemic fibrosis (NSF) is a severe fibrosing condition associated with gadolinium-based contrast agents (GBCAs) in patients with renal impairment.
- The latency period between GBCA exposure and NSF onset typically ranges from weeks to months, rarely exceeding 3.5 years.
Observation:
- A long-term hemodialysis patient received multiple GBCA administrations between 1998 and 2004.
- In 2014, the patient presented with new-onset dermal papules and plaques, a decade after his last known gadolinium exposure.
Findings:
- Skin biopsy revealed characteristic histopathological features of NSF, including dermal collagen thickening, CD34+ spindle cells, and increased mucin deposition.
- This case documents NSF developing 10 years post-gadolinium exposure, significantly extending the previously recognized latency period.
Implications:
- The findings suggest that patients with prior GBCA exposure, even many years prior, remain at risk for developing NSF.
- This underscores the importance of maintaining a high index of suspicion for NSF in patients with kidney disease and a history of gadolinium exposure, regardless of the exposure timeframe.
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