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A 70-year-old man was admitted to the hospital for evaluation of thickening of the skin. Four years earlier, he had undergone kidney transplantation for hypertension-induced end-stage renal disease. Two months before this admission, hemodialysis was reinitiated because of allograft failure. At that time, magnetic resonance angiography of the transplanted kidney with gadolinium enhancement showed no evidence of renal-artery stenosis. Examination revealed flexion contracture of his right elbow with prominent induration of the skin. The skin of his legs and lower abdomen was also affected, but that of his upper abdomen, chest, left (dominant) arm, and face was spared. Biopsy revealed dermal fibrosis and septal fibrosis in the panniculus that was consistent with nephrogenic fibrosing dermopathy, an uncommon sclerosing skin condition that has been associated with the use of gadolinium in patients with renal failure. His skin thickening led to progressive immobility. He remained wheelchair-bound and continued to receive hemodialysis.
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