A unique case of nephrogenic systemic fibrosis from gadolinium exposure in a patient with normal eGFR

BMJ Case Rep. 2017 Oct 11:2017:bcr2017221016. doi: 10.1136/bcr-2017-221016.


A 57-year-old woman presented with swelling and thickening of the skin of the lower extremities. Three months prior to presentation, patient had MRI with gadolinium as part of an evaluation for suspected pancreatic malignancy. Creatinine levels at the time of gadolinium exposure were 0.9-1.2 mg/dL, with a corresponding estimated glomerular filtration rate of 64 mL/min/1.73m2 by modification of diet in renal disease equation. Twenty-four-hour urine creatinine clearance was performed as an outpatient following development of symptoms. This revealed a creatinine clearance of 23 mL/min, suggestive of advanced chronic kidney disease despite an estimated glomerular filtration rate of 64 mL/min/1.73m2 Skin biopsy was positive for sclerosing dermopathy. These findings, in addition to the temporal association with gadolinium exposure, led to the diagnosis of nephrogenic systemic fibrosis.

Keywords: contraindications and precautions; dermatology; renal system.

Publication types

  • Case Reports

MeSH terms

  • Contrast Media / adverse effects*
  • Female
  • Gadolinium / adverse effects*
  • Glomerular Filtration Rate
  • Humans
  • Magnetic Resonance Imaging*
  • Middle Aged
  • Nephrogenic Fibrosing Dermopathy / chemically induced
  • Nephrogenic Fibrosing Dermopathy / diagnosis*
  • Nephrogenic Fibrosing Dermopathy / therapy
  • Physical Therapy Modalities
  • Referral and Consultation
  • Treatment Outcome


  • Contrast Media
  • Gadolinium