Nephrogenic systemic fibrosis: is gadolinium to be blamed?

Nephrogenic Systemic Fibrosis is a sclero myxedema like systemic disorder characterized by erythematous, indurated, well-defined, plaques over the skin, seen commonly on limbs symmetrically, particularly in areas between ankle and mid-thigh and between wrist and mid-upper arm and also over trunk of the body. NSF is progressive, the plaques coalesce having ameboid advancing edge and skin becomes thickened and tight, leading to contractures. Patients may experience pruritus, causalgia and sharp pains over affected areas. Internal organ fibrosis also occurs involving heart, lung, liver, testis, meninges and skeletal muscles, with considerable morbidity and mortality.