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  • Title: Progressive arm and leg stiffness in a patient with chronic renal impairment.
    Author: Shin K, Granter SR, Coblyn JS, Gupta S.
    Journal: Nat Clin Pract Rheumatol; 2008 Oct; 4(10):557-62. PubMed ID: 18711420.
    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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