Physicians with self-diagnosed gadolinium deposition disease: a case series

Semelka, Richard C.; Ramalho, Miguel

doi:10.1590/0100-3984.2020.0073

Brasil

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Original Article • Radiol Bras 54 (4) • Jul-Aug 2021 • https://doi.org/10.1590/0100-3984.2020.0073 linkcopy

Physicians with self-diagnosed gadolinium deposition disease: a case series

Médicos com doença de deposição de gadolínio autodiagnosticada: relato de série

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective: The objective of this study was to allow physicians with self-diagnosed gadolinium deposition disease symptoms to report their own experience.

Materials and Methods: Nine physicians (seven females), with a mean age of 50.5 ± 8.3 years, participated in this case series. Nationalities were American (n = 6), British, Portuguese, and Romanian. Medical practices included internal medicine (n = 2), trauma surgery, ophthalmology, gastroenterology, psychiatry, family medicine, obstetrics/gynecology, and general practice.

Results: Genetically, eight of the physicians were of central European origin. Underlying autoimmune conditions were present in four. Symptoms developed after a single injection in one physician and after multiple injections in eight. The precipitating agent was gadobenate dimeglumine in four physicians, gadobutrol in three, gadoterate meglumine in one, and gadopentetate dimeglumine in one. The most consistent symptoms were a burning sensation, brain fog, fatigue, distal paresthesia, fasciculations, headache, and insomnia. Eight of the physicians were compelled to change their practice of medicine.

Conclusion: In the various physicians, gadolinium deposition disease showed common features and had a substantial impact on daily activity. Physicians are educated reporters on disease, so their personal descriptions should spark interest in further research.

Keywords: Gadolinium/adverse effects; Gadolinium DTPA/adverse effects; Physicians; Contrast media/adverse effects

Subject	Age (years)	Gender	Nationality	Specialty	Symptoms	Autoimmune history	Work status and legal action
1	40	Female	Portuguese	Psychiatry	Burning sensation and muscle pain; muscle stiffness and cramps; lower leg paresthesia; muscle fasciculations; fatigue; insomnia; transient difficulty in swallowing	Takayasu arteritis; ankylosing spondylitis	Discontinued work, no legal action
2	55	Female	American	Internal medicine	Bilateral pain extending from the forearms to the hands; burning sensation in a glove and stocking distribution and on the torso; fatigue; brain fog; muscle weakness	Autoimmune optic neuritis	Discontinued work, no legal action
3	40	Male	American	Ophthalmology	Burning sensation in a glove and stocking distribution; paresthesia of the extremities; sensory neuropathy of lower extremities; muscle fasciculations; insomnia; brain fog	None	Limited practice, contacted a personal injury attorney
4	59	Female	American	Family medicine	Muscle fasciculations; generalized burning sensation; blurred vision; tinnitus; headache; brain fog	None	Discontinued work, no legal action
5	62	Male	American	Gastroenterology	Fatigue; lower-extremity paresthesia	None	Works full time, no legal action
6	46	Female	Romanian	Obstetrics and gynecology	Transient mild laryngeal spasm; dull right rib pain; left leg paresthesia; blurred vision; whole- body paresthesia and electric shock sensation; burning sensation affecting the skin, with a pins and needles sensation affecting both forearms; fatigue/muscle weakness; insomnia; occasional headache; brain fog	None	Limited practice, now works full time, no legal action
7	44	Female	British	General practice	Pounding headache; headache; dysautonomia; arthralgia; brain fog; burning muscle pain; fatigue/muscle weakness	Ehlers-Danlos syndrome; celiac disease	Discontinued work, no legal action
8	57	Female	American	Internal medicine	Headache; lip numbness; leg cramps; burning sensation and pins and needles sensation in legs; myoclonic jerks; allodynia; fatigue; severe pain in the hands	Sarcoidosis	Limited practice, no legal action
9	52	Female	American	Trauma surgery	Right-sided burning sensation affecting the skin and subcutaneous tissue; insomnia; brain fog; headaches; gastroparesis; fasciculations; visual problems; glove and stocking distribution of pain, discoloration, and subcutaneous tissue doughiness	None	Discontinued work, no legal action

Subject	Clinical indication(s)	Number of doses	Precipitating dose (mmol/kg)	Precipitating GBCA	Timing of symptom onset after administration
1	Takayasu arteritis; ankylosing spondylitis	10	1.0	Gadoterate meglumine	Within hours
2	Possible multiple sclerosis (n = 5); concussion (n = 1)	6	0.6	Gadobenate dimeglumine	Within 2 weeks
3	Migraine headache with aura (n = 1); headaches/nausea (n = 1); posterior cervical lymphadenopathy (n = 1); firm, mobile skin nodule, anterior to the tibia, and leg pain (n = 1); abdominal MRI (n = 1)	5	0.2	Gadobenate dimeglumine	Within 1 day
4	Chronic hamstring tendon insertion avulsions (n = 1); leg pain (n = 2); MR arthrography; blurred vision, tinnitus, insomnia, and burning sensation (n = 1); MR angiography (n = 1)	5	0.1	Gadobutrol	Within days
5	Homonymous hemianopsia; moderate headache following intense exercise (n = 2)	2	0.2	Gadobenate dimeglumine	Within 2 weeks
6	Right-sided pulsatile tinnitus (n = 1); acute cholecystitis (n = 2)	3	0.2	Gadopentetate dimeglumine	Within days
7	Worsening of tinnitus (n = 3)	3	0.1	Gadobenate dimeglumine	Within hours
8	BRCA mutation (n = 4)	4	0.1	Gadobutrol	Within 3 days
9	Trauma after a motor vehicle accident (n = 1); symptoms that appeared after the first contrast-enhanced MRI (n = 11)	12	0.1	Gadobutrol	Within days

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