Erythema Nodosum Masking Nephrogenic Systemic Fibrosis As Initial Skin Manifestation

Overview

Journal BMC Nephrol

Publisher Biomed Central

Specialty Nephrology

Date 2017 Jul 26

PMID 28738858

Citations 2

Authors

Kar Wah Fuah

Christopher Thiam Seong Lim

Affiliations

Soon will be listed here.

Abstract

Background: Nephrogenic systemic fibrosis (NSF) is a complication of the gadolinium-based contrast agent used in imaging studies. It is typically characterised by hard, erythematous and indurated skin plaques with surrounding subcutaneous oedema. Distinct papules and subcutaneous nodules can also be seen. Fibrocytes in NSF are immunohistochemically positive for CD34.

Case Presentation: We present a case of NSF occurred after gadolinium exposure in which the initial presentation mimics an erythema nodosum (EN)-like picture. An initial skin biopsy showed EN. Subsequently the patient developed progressive skin and joints contracture. A repeated skin biopsy done three months later confirmed the diagnosis of NSF. As far as we are aware, this is the second reported case of NSF that mimicked the presentation of EN in the early phase of the disease.

Conclusions: The appearance of EN-like disease can be one of the early manifestations of NSF. We hope that early recognition of this unusual presentation can alert the physician or nephrologist to the potential diagnosis of NSF.

Citing Articles

Is it time to relax nephrogenic systemic fibrosis guidelines and safely offer magnetic resonance imaging to more patients?.

Al-Chalabi S, Chrysochou C, Kalra P Quant Imaging Med Surg. 2019; 9(11):1918-1921.

PMID: 31867244 PMC: 6902148. DOI: 10.21037/qims.2019.10.11.

Use of GBCA in MRIs for High-Risk Patients.

Heinz G, van der Molen A, Roditi G Fed Pract. 2019; 36(4):152-153.

PMID: 31138964 PMC: 6503911.

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