Case 35-2004: Nephrogenic Fibrosing Dermopathy

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Abstract
In Case 35-2004, Moschella et al. (Nov. 18 issue)1 discuss a patient with nephrogenic fibrosing dermopathy. There is growing evidence that the fibrosis may not be restricted to the skin but may be systemic, often involving the subcutaneous tissue, fascia, skeletal muscle, heart, lungs, and other organs.2-4 This evidence has led us to suggest an alternative name for this disorder — “dialysis-associated systemic fibrosis.”3,4 Certain features of the patient discussed in the case suggest that skeletal muscle was involved: progressive weakness, an inability to walk, prominent flexion contractures over the elbows and knees, and the “woody induration” of the feet, which can also occur in the calf and quadriceps muscles.4 We believe a muscle biopsy would have shown endomysial or perimysial fibrosis, or both ( Figure 1 ). We wish to emphasize the occurrence of a systemic fibrotic process in this disorder and to encourage a detailed and careful search for systemic involvement in similar patients.