Abstract
BACKGROUND: Gadolinium is the most widely used diagnostic heavy metal contrast agent in the Military Health System and Veterans Health Administration (VHA). Used for enhancing magnetic resonance imaging (MRI), gadolinium can also have toxic effects. From 1999 to 2025 use of contrast-enhanced MRI in VHA facilities has risen to a mean (SD) 2.6 (2.8) MRIs with gadolinium each for 939,928 patients. CASE PRESENTATION: A 65-year-old Air Force veteran and retired mechanical technician sought nephrology consultation. His medical history included posttraumatic stress disorder, cervical spondylosis, ulnar nerve injury, bilateral sensorineural hearing loss, dyslipidemia, and hypertension. Twenty-five days before consultation, the patient started a contrast-enhanced MRI for elevated prostate-specific antigens. During the MRI, he experienced claustrophobia, sweating, shortness of breath, a metallic taste, and hot sensations in the groin, chest, "kidneys," and lower back, and the MRI was halted. Some symptoms reappeared days later, resulting in a 4-day hospitalization. Serum gadolinium measured 0.1 ng/mL, and 24-hour urine gadolinium was 0.3 mcg. Back-extrapolation of gadolinium elimination rates suggested exposure to 0.5% to 8.0% of a standard contrast dose. At 107 days post-MRI, serum and urine gadolinium were undetectable, but the metallic taste persisted. CONCLUSIONS: Our findings suggest that detectable gadolinium in serum and urine may reflect subclinical exposure, even at doses below standard prescriptions. Clinicians must consider gadolinium as a potential cause of pleiotropic symptoms even when, as in this case, symptoms persist despite undetectable levels of gadolinium.