Background
Gadolinium-based contrast agents (GBCAs), benefiting from good tolerance and safety, become the priority contrast agents in magnetic resonance imaging (MRI). Serious hypersensitivity reactions caused by GBCAs are rare, but occur occasionally. The “immune surveillance” theory proposes that lowered immune function exists in patients with malignance, which decrease the occurrence of atopy. Natural immunosurveillance that enhanced by effective treatment of malignance may increase the risk of hypersensitivity.
Case presentation
A 29-year-old female patient suffered intensive pain with left leg mass was admitted in our hospital. She was diagnosed with alveolar soft part sarcoma by histopathological and revealed destruction of the left fibula and lung metastasis by computed tomography scan, and treated with anlotinib hydrochloride, a multi-targeted tyrosine kinase inhibitor. She underwent contrast-enhanced MRI twice using gadodiamide, without any discomfort. However, after four cycles of anlotinib hydrochloride, she developed severe immediate hypersensitivity due to gadopentetate dimeglumine-enhanced MRI for evaluating therapeutic regimen.
Conclusion
Severe immediate hypersensitivity might be occured by gadolinium contrast agent in patient with malignance after effective treatment. We explored the potential mechanism of GBCA-inducing hypersensitivity in detail, by especially focusing on the changes of immune environment. Furthermore, we propose new ideas for the safe use of GBCAs in patients with malignancies. However, to confirm the validity of these ideas, further research is required.