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  • Case Study
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Progressive arm and leg stiffness in a patient with chronic renal impairment

Nature Clinical Practice Rheumatology volume 4, pages 557–562 (2008)Cite this article

Abstract

Background A 60-year-old white woman with a history of breast cancer, autoimmune hemolytic anemia, type 2 diabetes mellitus, peripheral vascular disease, and chronic renal insufficiency presented with stiffness in her arms and legs of 3 months' duration. She had undergone multiple MRI and magnetic resonance angiography examinations with gadolinium-containing contrast media over the last 2 years.

Investigations Complete physical examination including thorough skin examination; laboratory examinations including CBC, urinalysis, serum creatinine, protein electrophoresis and C-reactive protein; antinuclear antibody assay; Westergren erythrocyte sedimentation rate; and an excisional skin biopsy.

Diagnosis Nephrogenic systemic fibrosis (also known as nephrogenic fibrosing dermopathy).

Management Symptomatic treatment, physical therapy, and a brief trial of imatinib mesylate.

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Figure 1: Histopathology of deep-skin biopsy samples of the case patient.
Figure 2: Cutaneous thickening and hardening with firm nodular lesions in the lower extremity.

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Acknowledgements

Charles P Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the Medscape-accredited continuing medical education activity associated with this article.

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Author notes

  1. K Shin is a Clinical Fellow, SR Granter is an Associate Pathologist, JS Coblyn is the Director of Clinical Rheumatology, and S Gupta is an Associate Physician in the Division of Rheumatology, Immunology and Allergy, at Brigham and Women's Hospital, Boston, MA, USA. All of the authors are affiliated with Harvard Medical School, Boston, MA, USA.

Authors and Affiliations

  1. Boston VA Health Care and Division of Rheumatology, Section of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, 75 Francis Street, Boston, 02115, MA, USA

    Samardeep Gupta

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  1. Kichul Shin
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Correspondence to Samardeep Gupta.

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Shin, K., Granter, S., Coblyn, J. et al. Progressive arm and leg stiffness in a patient with chronic renal impairment. Nat Rev Rheumatol 4, 557–562 (2008). https://doi.org/10.1038/ncprheum0883

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