Gadopentetate dimeglumine extravasation resulting in cutaneous ulceration: a case report

BACKGROUND: Extravasation of gadolinium-based contrast agents (GBCAs) during magnetic resonance imaging is a rare adverse event, with most cases resolving without significant complications. However, severe tissue injury following GBCA extravasation remains extremely rare and incompletely characterized in the existing literature. CASE PRESENTATION: A 58-year-old female (Chinese, Asian) with hepatocellular carcinoma and ongoing chemotherapy experienced gadopentetate dimeglumine extravasation during an abdominal magnetic resonance imaging (MRI) examination. Despite standard initial management-including immediate catheter removal, ice application, limb elevation, and topical heparinoid cream administration-the patient developed a tension blister within four hours, followed by progressive tissue necrosis and a deep cutaneous ulcer. The ulceration was further complicated by secondary infection, likely secondary to inappropriate self-management of the blister. The patient underwent a prolonged wound care regimen, culminating in complete re-epithelialization after four weeks, with no residual functional impairment. CONCLUSION: This case underscores the potential severity of cutaneous complications resulting from GBCA extravasation, especially in high-risk patients with chemotherapy-induced vascular vulnerability or diminished tissue integrity. It emphasizes the critical importance of vigilant post-extravasation monitoring, proactive patient education to prevent inappropriate self-management of the injury, and the implementation of structured wound care protocols. Future studies are warranted to establish evidence-based preventive strategies and therapeutic guidelines for GBCA-related extravasation injuries.