Nephrogenic systemic fibrosis associated with liver transplantation, renal failure and gadolinium

The Australasian Journal of Dermatology
Tony Caccetta, Jonathan J Chan

Abstract

A 47-year-old man underwent liver transplantation for cirrhosis secondary to hepatitis C and alcoholism. This was complicated by primary donor liver dysfunction and acute renal failure requiring dialysis. Gadolinium magnetic resonance cholangiopancreatography was performed 2 weeks post transplant, and a second successful liver transplant was performed 1 week later. Shortly after this, the patient developed rapidly progressive erythematous plaques over his abdomen, lower and upper limbs. There was marked oedema and skin induration. Fibrosis severely limited his mobility, leaving him wheelchair-bound. An abdominal plaque biopsy revealed increased dermal mucin and cellularity, with proliferation of spindled fibroblastic cells. Paraprotein was not detected in the serum. Facial sparing, the absence of serum paraprotein and the histopathological findings confirmed the diagnosis of nephrogenic systemic fibrosis. Immunohistochemical stains revealed CD34-positive spindle-shaped cells, and electron microscopy did not detect free gadolinium. Following improvement in renal function and various treatments, his plaques softened, fibrosis slowed and mobility partially improved. Gadolinium magnetic resonance cholangiopancreatography was perfor...Continue Reading

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Citations

Sep 25, 2008·Journal of Medical Imaging and Radiation Oncology·A J van der Molen
Sep 23, 2008·AJR. American Journal of Roentgenology·Frank G Shellock, Alberto Spinazzi
May 17, 2011·Indian Journal of Dermatology·Zhitong Zou, Lin Ma
Mar 4, 2014·Clinical Radiology·L Daftari BesheliH Abujudeh
Jun 15, 2010·Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia·Andrew J GaudenKatharine J Drummond
Nov 27, 2009·Journal of the American Academy of Dermatology·Alan S BoydJerrold L Abraham
Apr 14, 2009·Annales de dermatologie et de vénéréologie·P SenetD Lipsker
Jul 22, 2008·Pharmacoepidemiology and Drug Safety
Nov 26, 2009·Journal of Magnetic Resonance Imaging : JMRI·Martin R PrinceWalter Kucharczyk
Nov 26, 2009·Journal of Magnetic Resonance Imaging : JMRI·Sameer M MazharClaude B Sirlin
Oct 22, 2014·The Australasian Journal of Dermatology·Christopher RossDavid Astill
Nov 19, 2011·JACC. Cardiovascular Imaging·Zhitong ZouMartin R Prince
Oct 1, 2010·NDT Plus·Rachel Davison, Paul Mead

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