A rare case of acute respiratory distress syndrome caused by use of gadolinium-based magnetic resonance imaging contrast media

Abstract

Gadolinium-based magnetic resonance imaging (MRI) contrast is generally considered to be stable and safe. Adverse reactions due to MRI contrast agents are classified into allergic-like reactions and physiological reactions. Acute respiratory distress syndrome (ARDS) caused by gadolinium-based MRI contrast is extremely rare. Due to the immediate and severe nature of ARDS, medical practitioners may seek after other aetiologies other than MRI-contrast-induced ARDS for patients' clinical manifestations such as acute-onset difficulty of breathing. It is crucial to keep in mind the possibility of ARDS after gadolinium injection, as missing the diagnosis leads to a high mortality. A clear clinical scenario of ARDS induced by gadobutrol (Gadovist, Bayer Inc., Toronto, Canada) was presented in our patient who did not develop symptoms of anaphylaxis. We successfully managed the patient with methylprednisolone and bilevel positive airway pressure ventilation and the patient was discharged in stable condition on day 6.