Friday, February 5, 2010

Renal III

A patient with renal failure of unknown etiology requiring dialysis went to get a pan-body CT/MRI three weeks ago. She is fairly wealthy and paid for as many fancy technological scans as possible in an attempt to identify the cause of her renal failure. Today, she presents with the lesion shown in the first image. These lesions developed symmetrically on bilateral ankles, lower legs, feet, and hands. Then they may progress to the thighs, forearms, trunk, and buttocks. The second image shows a later stage.

CRP, serum ferritin, and ESR are elevated; albumin is low. ANA, anticentromere, and anti-Scl-70 antibodies are negative.

Challenge: What happened?

Images shown under Fair Use.


Suheil said...

aaagghhhh.. not the slightest clue..
but wat the hell.. could it be HSP?

Craig Chen said...

haha HSP is always a good guess with rash & renal.
Renal III

Nephrogenic systemic fibrosis or nephrogenic fibrosing dermopathy is thickening and hardening of the skin overlying the extremities and trunk with expansion and fibrosis of the dermis with CD34+ fibrocytes. This occurs only in patients with renal failure and may be due to gadolinium exposure. The skin disease presents as symmetric bilateral fibrotic indurated papules, plaques, or subcutaneous nodules +/- erythema. Involved skin may be thickened and firm with cobblestoning or a woody peau d'orange appearance. Lesions may be pruritic, painful, burning, and may limit joint flexibility.

Sources: UpToDate;

Suheil said...

Whoa! So u weren't kidding abt the difficulty! Damn! Good one Chief! Keep it coming :)