MWE
using CairoMakie
CairoMakie.activate!()
using FileIO
using Makie
img = load(Makie.assetpath("doge.png"))
i = image(permutedims(img)[:,end:-1:1])
save(joinpath(@__DIR__, "mwe.pdf"), i)
Output:

Adding fxaa=true to image does not fix it either.
Saving as png does work though.
Related: #2080