Nephrogenic systemic fibrosis with multiorgan involvement in a teenage male after lymphoma, Ewing's sarcoma, end-stage renal disease, and hemodialysis

Pediatr Dev Pathol. Sep-Oct 2007;10(5):395-402. doi: 10.2350/06-05-0093.1.


Nephrogenic systemic fibrosis (NSF) is a rare condition that always occurs after acute or chronic renal failure with or without dialysis. The vast majority of cases in the literature are adults, and postmortem findings have been reported in only 5 cases. We report a 15-year-old male who developed NSF with multiorgan involvement after successful treatment of renal lymphoma and a subsequent sacral Ewing's sarcoma, and end-stage renal disease treated with hemodialysis. At autopsy, he was found to have diffuse dural osseous metaplasia, transmural bronchiolar fibrosis, diaphragmatic central tendon fibrosis, and fibrous plaques of the mitral valve. These previously unreported findings expand the spectrum of multiorgan involvement in NSF providing additional evidence that it is an emerging systemic disorder.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Antineoplastic Agents / adverse effects
  • Bone and Bones / pathology
  • Calcinosis / etiology
  • Calcinosis / pathology
  • Dura Mater / pathology
  • Fibrosis
  • Humans
  • Kidney Failure, Chronic / chemically induced
  • Kidney Failure, Chronic / complications*
  • Kidney Failure, Chronic / therapy
  • Kidney Neoplasms / drug therapy
  • Kidney Neoplasms / radiotherapy
  • Kidney Transplantation
  • Lung Diseases / etiology
  • Lung Diseases / pathology
  • Lymphoma, Large B-Cell, Diffuse / drug therapy
  • Lymphoma, Large B-Cell, Diffuse / pathology*
  • Lymphoma, Large B-Cell, Diffuse / radiotherapy
  • Male
  • Metaplasia
  • Mitral Valve / pathology
  • Neoplasms, Second Primary / pathology
  • Radiotherapy / adverse effects
  • Renal Dialysis* / adverse effects
  • Sarcoma, Ewing / drug therapy
  • Sarcoma, Ewing / pathology*
  • Skin Diseases / etiology*
  • Skin Diseases / pathology


  • Antineoplastic Agents