Department of Dermatology, University of Virginia School of Medicine, Charlottesville.
Department of Dermatopathology, University of Virginia School of Medicine, Charlottesville.
JAMA Dermatol. 2015 Oct;151(10):1117-20. doi: 10.1001/jamadermatol.2015.0976.
Nephrogenic systemic fibrosis (NSF) is a fibrosing skin disorder that develops in patients with kidney failure and has been linked to exposure to gadolinium-containing contrast agents. The time between exposure to gadolinium and the initial presentation of NSF is typically weeks to months but has been documented to be as long as 3½ years. We report a case of NSF developing 10 years after exposure to gadolinium.
A long-term hemodialysis patient was exposed to gadolinium several times between 1998 and 2004 during magnetic resonance angiography of his abdominal vessels and arteriovenous fistula. In 2014, he was seen at our clinic with new dermal papules and plaques. Biopsy of affected skin showed thickening of collagen, CD34+ spindle cells, and increased mucin in the dermis, supporting the diagnosis of NSF.
The clinical history and histopathological features of this case support the diagnosis of NSF 10 years after exposure to gadolinium. Although the use of gadolinium contrast agents in patients with kidney failure has markedly decreased, patients with exposure to gadolinium years to decades previously may manifest the disease.
肾源性系统性纤维化（NSF）是一种纤维性皮肤疾病，发生于肾衰竭患者，与接触含钆造影剂有关。接触钆和 NSF 初始表现之间的时间通常为数周到数月，但已有长达 3 年半的记录。我们报告了一例 NSF 在接触钆 10 年后发生的病例。
一位长期血液透析患者在 1998 年至 2004 年期间因腹部血管和动静脉瘘的磁共振血管造影术多次接触钆。2014 年，他在我院就诊时出现新的皮肤丘疹和斑块。受影响皮肤的活检显示胶原增厚、CD34+梭形细胞和真皮中粘蛋白增加，支持 NSF 的诊断。
本例的临床病史和组织病理学特征支持 NSF 诊断，在接触钆 10 年后发生。尽管肾衰竭患者使用钆造影剂的情况明显减少，但数年前至数十年前接触过钆的患者可能会出现这种疾病。
