1
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Goh JW, Ong CK, Abdullah KM. Porphyria cutanea tarda: an under-recognised manifestation of haemochromatosis. BMJ Case Rep 2023; 16:e253203. [PMID: 37678939 PMCID: PMC10496723 DOI: 10.1136/bcr-2022-253203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023] Open
Abstract
We present a case of a woman who presented with a photosensitive skin rash and blisters on her extremities which did not improve with steroids. These were associated with polyarthralgia and a deranged liver function test on her admission. Further workup revealed that the patient has an undiagnosed porphyria cutanea tarda (PCT) and hereditary haemochromatosis. The patient later underwent regular venesections which improved her condition. This case report not only illustrates the challenge in diagnosing PCT but also aims to highlight the association between PCT and hereditary haemochromatosis.
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Affiliation(s)
- Jing Wei Goh
- Respiratory Medicine, University Hospitals Birmingham, Birmingham, UK
| | - Cheng Ken Ong
- Cardiology Department, Fairfield General Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, UK
| | - Khaled M Abdullah
- Internal Medicine Department, University of California San Francisco, Fresno, California, USA
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2
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Serrano-Ordóñez A, Godoy-Díaz DJ, Lova-Navarro M. Porphyria Cutanea Tarda in a Patient with Myelofibrosis. Sultan Qaboos Univ Med J 2023; 23:274-275. [PMID: 37377838 PMCID: PMC10292583 DOI: 10.18295/squmj.1.2023.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/30/2023] [Accepted: 02/05/2023] [Indexed: 02/24/2023] Open
Affiliation(s)
- Ana Serrano-Ordóñez
- Department of Dermatology, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Daniel J. Godoy-Díaz
- Department of Dermatology, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Miguel Lova-Navarro
- Department of Dermatology, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
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3
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Pavlidou DC, Van Winckel G, Tran C. When Simple Phlebotomy Is the Cure: Porphyria Cutanea Tarda. J Gen Intern Med 2022; 37:3489-3490. [PMID: 35879535 PMCID: PMC9551155 DOI: 10.1007/s11606-022-07740-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/01/2022] [Indexed: 10/16/2022]
Affiliation(s)
- Despina Christina Pavlidou
- Center for Molecular Diseases, Division of Genetic Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Christel Tran
- Center for Molecular Diseases, Division of Genetic Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
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4
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Ghosh S, Bajad S, Tanna D, Sharma L, Bajaj R, Gupta R. Not Only Skin Deep-A Rare Case of Porphyria Cutanea Tarda With Corneal Opacity Presenting Along With Scleroderma With Interstitial Lung Disease. J Clin Rheumatol 2021; 27:S804-S805. [PMID: 35073640 DOI: 10.1097/rhu.0000000000001457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Shounak Ghosh
- From the Department of Rheumatology & Clinical Immunology, Medanta-The Medicity, Gurgaon, Haryana, India
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5
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Prasad S, Vidhata V, Prasad S. Sight-threatening progressive corneo-scleral involvement in porphyria cutanea tarda. BMJ Case Rep 2021; 14:e245160. [PMID: 34667041 PMCID: PMC8527116 DOI: 10.1136/bcr-2021-245160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2021] [Indexed: 11/04/2022] Open
Abstract
Porphyria cutanea tarda is the most common type of porphyria. It is associated with a deficiency of uroporphyrinogen decarboxylase enzyme responsible for heme synthesis. Clinical manifestations are predominantly dermatological and very rarely present with ocular involvement. Although scleral thinning in the interpalpebral area is a well-documented entity, sight-threatening corneal involvement is rarely described. We, herein report a case of a 58-year-old man who presented with ocular surface dryness, photophobia and mild redness. Slit-lamp biomicroscopy revealed corneo-scleral thinning in both eyes. The diagnosis was confirmed with a urine porphyrin test, serum iron and serum ferritin levels. We started him on conservative management after which he was lost to follow-up. He presented again after 6 years with total corneal opacification and progressive loss of vision in the right eye.
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Affiliation(s)
- Sonali Prasad
- Department of Ophthalomology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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6
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Affiliation(s)
- Mauricio F Jin
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, MN
| | - Carilyn N Wieland
- Division of Dermatopathology, Department of Dermatology, Mayo Clinic, Rochester, MN.
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7
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Neeleman RA, Wensink D, Wagenmakers MAEM, Mijnhout GS, Friesema ECH, Langendonk JG. Diagnostic and therapeutic strategies for porphyrias. Neth J Med 2020; 78:149-160. [PMID: 32641543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Porphyrias are rare metabolic disorders. Lack of awareness and knowledge about the clinical features of porphyrias results in diagnostic and therapeutic delays for many patients. Delays in diagnosing and treating porphyrias can result in severe, progressive morbidity (and mortality) and psychological distress for patients. This review discusses the pathophysiology, diagnosis, treatment, and follow-up of the most prevalent porphyrias: acute intermittent porphyria, porphyria cutanea tarda, and erythropoietic protoporphyria.
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Affiliation(s)
- R A Neeleman
- Porphyria Center Rotterdam, Center for Lysosomal and Metabolic Diseases, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, the Netherlands
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8
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Lederhandler M, Chen L, Meehan SA, Brinster NK, Neimann A. A case of porphyria cutanea tarda in the setting of hepatitis C infection and tobacco usage. Dermatol Online J 2019; 25:13030/qt11p0982m. [PMID: 32045169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 01/27/2020] [Indexed: 06/10/2023] Open
Abstract
Porphyria cutanea tarda (PCT) is the most common type of porphyria, presenting in middle-aged patients with a photodistributed vesiculobullous eruption, milia, and scars. Porphyria cutanea tarda occurs in relation to inhibition of uroporphyrinogen decarboxylase, a key enzyme in the heme biosynthesis pathway. A number of genetic and acquired factors increase susceptibility to PCT by reducing uroporphyrinogen decarboxylase activity. A handful of other vesiculobullous conditions may mimic PCT both clinically and histologically; therefore, both skin biopsy and laboratory evaluation are helpful in confirming the diagnosis. We report a case of PCT in the setting of cigarette usage and untreated hepatitis C infection.
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Affiliation(s)
- M Lederhandler
- The Laser Skin & Surgery Center of New York, New York, NY New York University Langone Medical Center, The Ronald O. Perelman Department of Dermatology, New York, NY.
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9
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Bazewicz CG, Helm MF, Miller JJ. Chronic blistering rash on hands. J Fam Pract 2019; 68:519-521. [PMID: 31725138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The location of the patient's lesions and multiple risk factors suggested that an uncommon disorder was at work.
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Affiliation(s)
| | - Matthew F Helm
- Department of Dermatology, Penn State Milton S. Hershey Medical Center, PA, USA
| | - Jeffrey J Miller
- Department of Dermatology, Penn State Milton S. Hershey Medical Center, PA, USA
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10
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Atmatzidis DH, Hoegler K, Weiss A, Lambert WC, Schwartz RA. Unsafe Deposits: Overlapping Cutaneous Manifestations of Porphyria Cutanea Tarda, Ochronosis, Hemochromatosis, and Argyria. Skinmed 2019; 17:161-170. [PMID: 31496470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Cutaneous deposition disorders represent an array of conditions resulting from the accumulation of endogenous and exogenous substances within the skin. Many of the deposition diseases resemble each other and can also be confused with disorders not related to deposition. Porphyria cutanea tarda (PCT) results from dysfunction particularly in the fifth enzyme of the heme synthesis pathway, leading to increased skin fragility and bullae among other abnormalities. Ochronosis develops from alkaptonuria or exogenous sources, creating deposition of ocher-colored pigment in the skin. Hemochromatosis is a systemic disorder that can be inherited or acquired, altering skin pigmentation in more than 90% of patients. PCT can be an initial manifestation of hemochromatosis. Argyria is an acquired disorder of silver deposition that can also cause pigmentation similar to ochronosis. These uncommon but not rare disorders may resemble and be confused with each other in multiple ways.
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Affiliation(s)
- Douglas H Atmatzidis
- Department of Dermatology, Rutgers University - New Jersey Medical School, Newark, NJ
- Department of Pathology, Rutgers University - New Jersey Medical School, Newark, NJ
| | - Karl Hoegler
- Department of Dermatology, Rutgers University - New Jersey Medical School, Newark, NJ
- Department of Pathology, Rutgers University - New Jersey Medical School, Newark, NJ
| | - Amy Weiss
- Department of Dermatology, Rutgers University - New Jersey Medical School, Newark, NJ
- Department of Pathology, Rutgers University - New Jersey Medical School, Newark, NJ
| | - W Clark Lambert
- Department of Dermatology, Rutgers University - New Jersey Medical School, Newark, NJ;
- Department of Pathology, Rutgers University - New Jersey Medical School, Newark, NJ
| | - Robert A Schwartz
- Department of Dermatology, Rutgers University - New Jersey Medical School, Newark, NJ
- Department of Pathology, Rutgers University - New Jersey Medical School, Newark, NJ
- Rutgers University School of Public Affairs and Administration, Newark, NJ
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11
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Rodriguez O, Mosojane K, Williams V. Letters from Botswana: Photosensitive Eruption in an HIV-Positive Patient. Skinmed 2019; 17:135-137. [PMID: 31145069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Olaf Rodriguez
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA;
| | | | - Victoria Williams
- Ministry of Health of Botswana, Gaborone, Botswana
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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12
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Parajuli N, Jha HK, Jonkman MF. Porphyria Cutanea Tarda Presenting as Erythema-multiforme Like Lesions. J Nepal Health Res Counc 2019; 17:119-121. [PMID: 31110391 DOI: 10.33314/jnhrc.1132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 04/24/2019] [Indexed: 06/09/2023]
Abstract
Porphyria cutaneatarda, is the most common type of porphyria.It is characterized by defective uroporphyrinogen III decarboxylase enzyme.It presents with erosion, bulla with milia formation and sometimes with hypertrichosis and abnormal pigmentation mostly on the photo-exposed sites. A urine fluorescence of coral red color helps in the diagnosis. Here, we present a rare case of porphyria cutanea tarda in a 15 years old male who presented with multiple targetoid plaques. Keywords: Erythema-multiforme; porphyria cutanea tarda; targetoid.
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Affiliation(s)
- Niraj Parajuli
- Department of dermatology and venereology, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | | | - Marcel F Jonkman
- University of Groningen, University Medical Center Groningen, Department of Dermatology, Groningen, the Netherlands.
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13
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Trier Brix A, Lindegaard Christensen A, Bygum A. Blisters, Sores and Scars on the Dorsal Hands in a 17-year-old Girl: A Quiz. Acta Derm Venereol 2018; 98:815-816. [PMID: 29738046 DOI: 10.2340/00015555-2962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Anna Trier Brix
- Department of Dermatology and Allergy Centre, Odense University Hospital, DK-5000 Odense C, Denmark
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14
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Feldman S, Edwards T, Meltem Akkurt Z. Hyperpigmented Patches on the Dorsal Hands. Am Fam Physician 2018; 97:603-604. [PMID: 29763264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
| | - Taylor Edwards
- Ohio University Heritage College of Osteopathic Medicine, Athens, GA, USA
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15
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Modesto Dos Santos V. Pseudo porphyria or porphyria cutanea tarda? Rev Gastroenterol Peru 2018; 38:111-112. [PMID: 29791431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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16
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Affiliation(s)
- D Montgomery Bissell
- From the Department of Medicine, Division of Gastroenterology and Porphyria Center, University of California, San Francisco, San Francisco (D.M.B.); the Departments of Preventive Medicine and Community Health and Internal Medicine, Division of Gastroenterology and Hepatology, University of Texas Medical Branch, Galveston (K.E.A.); and the Department of Gastroenterology, Wake Forest School of Medicine, Winston-Salem, NC (H.L.B.)
| | - Karl E Anderson
- From the Department of Medicine, Division of Gastroenterology and Porphyria Center, University of California, San Francisco, San Francisco (D.M.B.); the Departments of Preventive Medicine and Community Health and Internal Medicine, Division of Gastroenterology and Hepatology, University of Texas Medical Branch, Galveston (K.E.A.); and the Department of Gastroenterology, Wake Forest School of Medicine, Winston-Salem, NC (H.L.B.)
| | - Herbert L Bonkovsky
- From the Department of Medicine, Division of Gastroenterology and Porphyria Center, University of California, San Francisco, San Francisco (D.M.B.); the Departments of Preventive Medicine and Community Health and Internal Medicine, Division of Gastroenterology and Hepatology, University of Texas Medical Branch, Galveston (K.E.A.); and the Department of Gastroenterology, Wake Forest School of Medicine, Winston-Salem, NC (H.L.B.)
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17
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Hy L, Ho HW. Performing therapeutic venesection in a doctor's surgery. Aust Fam Physician 2017; 46:132-138. [PMID: 28260267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Although venesection was widely applied in the past for the treatment of various ailments and diseases, in modern medical practice, it is indicated in very few conditions, namely, hereditary haemochromatosis, polycythaemia and porphyria cutanea tarda. OBJECTIVE This article briefly reviews the pathophysiology of these conditions, and the rationale and goals of therapeutic venesection as a treatment modality. It also summarises the venesection procedure itself and the considerations for setting up a venesection service in a doctor's surgery. DISCUSSION Venesection is generally safe and carries few side effects. Before commencing therapeutic venesection, management goals in terms of laboratory parameters should be set for individual patients. These patients should be monitored regularly so that set targets are met and not overshot as to render them anaemic and acutely symptomatic. Venesections should also be performed by persons familiar with the procedure and management of the attendant complications.
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18
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Howard M, Hall A, Ramsay D. Congenital erythropoietic porphyria (Gunther disease) - long-term follow up of a case and review. Dermatol Online J 2017; 23:13030/qt10n7k90g. [PMID: 28329491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 02/16/2017] [Indexed: 06/06/2023] Open
Abstract
Patients with the rare genodermatosis congenitalerythropoietic porphyria (CEP, Gunther disease)develop erosions and scarring on sun-exposedsites caused by phototoxin mediated damage.Compromised skin barrier function places patientsat higher risk of infection and long term sequelaeinclude scarring. We report a long term follow up ofa 60 year old patient born with CEP and provide anextensive literature review of CEP including recentupdates on potential management options. Multiplepatient interviews and collection of biochemistry datawere conducted for the case discussion. All Australianpathology laboratories in each state performingporphyria testing were surveyed in mid 2015 to verifyexistence of other cases of CEP in Australia with onlyone case of true congenital porphyria identifiedand one adult onset case. Congenital erythropoieticporphyria is a rare condition with no cure currentlyavailable. It is important to diagnose patients earlyto prevent and minimize complications such asscarring and secondary infection, provide longterm skin checks, and advise patients about lifestylemodification.
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Affiliation(s)
- Matthew Howard
- St Vincent's Hospital, Melbourne, Victoria, Australia. matthew.david.
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Affiliation(s)
- Allen Shih
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - William Damsky
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Amanda Zubek
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
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20
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Strauss MM, Shetty A, Witheiler D. Bullous Skin Lesions in a Patient with End-Stage Renal Disease and Hepatitis C. Adv Perit Dial 2016; 32:56-60. [PMID: 28988591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Bullous lesions in patients with end-stage renal disease are uncommon and can pose diagnostic and therapeutic challenges. We present a female patient with end-stage renal disease, bullous skin lesions affecting mainly sun-exposed areas, and high ferritin levels. She also had hepatitis C. Her serum porphyrin panel was suggestive of porphyria cutanea tarda. Skin biopsy excluded inflammatory pathologies. Phlebotomy during each hemodialysis, continuation of darbepoetin, and avoidance of any further doses of intravenous iron, with close monitoring of hemoglobin, resulted in a gradual drop in ferritin level and improvement of the skin lesions.
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Affiliation(s)
| | - Anupkumar Shetty
- Methodist Dallas Medical Center, Dallas, Texas, U.S.A
- Dallas Nephrology Associates, Dallas, Texas, U.S.A
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21
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Pranteda G, Bottoni U, Tayefeh Jafari M, Pranteda G, De Micco S, Muscianese M, Menè P. Dialysis-associated pseudoporphyria successfully treated with vitamin D. Report of two cases. GIORN ITAL DERMAT V 2015; 150:327-329. [PMID: 25946676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Pseudoporphyria refers to a rare bullous dermatosis characterized by the clinical and histological features of porfiria cutanea tarda without abnormalities in porphyrin metabolism. The pathogenesis is heterogeneous and several exogenous factors may promote the bullous lesion formation, including medications, end stage renal disease, dialysis and tanning beds. Regarding treatment of this condition, in literature different therapy have been reported, such as glutathione and his precursor N-acetylcysteine, which presents anti-oxidant properties; however even more toxic drugs, such as chloroquine, are used. Moreover, in patients with drug-induced PP discontinuation of the offending agent, if possible, is a crucial aspect of the clinical management. We report two cases of dialysis patients presenting blisters on extremities, which healed with the avoidance of UV exposure and oral Vitamin D supplementation. Interestingly Vitamin D despite the lack of antioxidant properties led to a completely resolution of PP in both our patients within 30 days. A possible explanation of this finding is that Vitamin D, playing a key role in the regulation of serum Ca2+, can modulated cadherin-cadherin interactions and led to healing of pseudoporphyria bullous lesions. Finally we highlight the prominent role of UV-exposure in PP elicitation thus a good photoprotection is essential for all patients with pseudoporphyria.
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Affiliation(s)
- G Pranteda
- Unit of Dermatology, NESMOS Department, Faculty of Medicine, Sant'Andrea" Hospital "Sapienza" University, Rome, Italy -
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Velander MJ, Þorsteinsdóttir S, Bygum A. [Clinical review of pseudoporphyria]. Ugeskr Laeger 2015; 177:V11140599. [PMID: 25650579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Pseudoporphyria is a photosensitive bullous disease, which resembles porphyria cutanea tarda. Normal porphyrin levels in urine, stool and blood define pseudoporphyria. Pseudoporphyria is associated with chronic renal failure, haemodialysis, a variety of drugs (e.g. naproxen, nabumetone, furosemide, ciprofloxacin, voriconazole, acitretin), tanning beds and UVA exposure. Treatment consists of UV protection and cessation of suspected agents. Patients in haemodialysis can benefit from treatment with N-acetylcysteine or glutathione.
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Affiliation(s)
- Marie Juul Velander
- Medicinsk Afdeling, Odense Universitetshospital, Svendborg Sygehus, Valdemarsgade 53, 5700 Svendborg. /
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Abstract
A 24-year-old man presented with pain, sticky discharge and loss of vision in the right eye. He has had typical skin manifestations of porphyria cutanea tarda (PCT) since 6 years and ophthalmological symptom for 6 weeks. On ophthalmological examination, visual acuity was light perception in the right eye and 6/12 in the left. There were bilateral, symmetrical temporal scleromalacia along with temporal corneal melting in both eyes and perforation in the right eye. Ultrasonography B-scan (USG B-scan) revealed a retinal detachment in the right eye. Artificial tear instillation was started every hour along with topical antibiotic coverage in both eyes. Additionally, ultraviolet protective sunglasses and hat for photo-protection was advised. The vision in the right eye improved to 5/60 along with subsidence of retinal detachment on repeat USG B-scan after 3 weeks.
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Affiliation(s)
- Pratik Yeshwant Gogri
- Department of Ophthalmology, Pravara Institute of Medical Sciences, Loni, Maharashtra, India
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24
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Ting P, Adams S. Dermacase. Can you identify this condition? Porphyria cutanea tarda. Can Fam Physician 2013; 59:749-755. [PMID: 23851543 PMCID: PMC3710043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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25
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Battistella M. [Case no. 5. Bullous dermatosis]. Ann Pathol 2013; 33:196-201. [PMID: 23790661 DOI: 10.1016/j.annpat.2013.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 04/09/2013] [Indexed: 11/17/2022]
Affiliation(s)
- Maxime Battistella
- Service d'anatomie et de cytologie pathologiques, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France.
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26
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Affiliation(s)
- Y-C Huang
- Department of Dermatology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
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Du-Thanh A, Aguilar-Martinez P, Enescu C, Cunat S, Guillot B, Dereure O. Porphyria cutanea tarda and spherocytosis: a non-random association? Acta Derm Venereol 2013; 93:377-8. [PMID: 23093332 DOI: 10.2340/00015555-1493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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29
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Lee CH, Yuen MMA, Chow WS, Tso AWK, Yeung CK, Chan JCY, Chau CH, Lam KSL. A man with a blistering eruption and tuberculosis. BMJ 2012; 344:d8351. [PMID: 22228698 DOI: 10.1136/bmj.d8351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Chi-Ho Lee
- Department of Medicine, Queen Mary Hospital, Pokfulam, Hong Kong.
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Van Meter JR, Tierney KR, Pittelkow MR. Iron, genes, and viruses: the porphyria cutanea tarda triple threat. Cutis 2011; 88:73-76. [PMID: 21916273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Porphyria cutanea tarda (PCT) is a vesiculobulIous disorder often associated with estrogens, hepatitis C virus (HCV), alcoholism, hereditary hemochromatosis (HH), and human immunodeficiency virus. Hepcidin, a peptide hormone produced by the liver, has been associated with iron metabolism in 3 common precipitating factors for PCT: HCV, HH, and alcohol consumption. We present the case of a patient with erosions and noninflammatory bullae on his hands and forearms who received a diagnosis of PCT. On further examination, the patient was found to be positive for 3 precipitating factors: HCV, an HH gene mutation, and alcohol use. For patients with PCT, it is important to perform phenotypic screening for HCV and HH. Targeting hepcidin with replacement therapy to decrease iron may be a treatment of not only HCV, HH, and alcoholic cirrhosis, but also PCT.
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Affiliation(s)
- Jonathan R Van Meter
- Department of Dermatology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
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Mazzarolo SS. Blistering eruption on the leg of an adult. Am Fam Physician 2011; 84:231-232. [PMID: 21766776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Royer-Bégyn M, Teira P, Deybach JC, Mas E, Mazereeuw-Hautier J. [Porphyria cutanea tarda in a child undergoing bone marrow grafting]. Ann Dermatol Venereol 2010; 137:640-4. [PMID: 20932445 DOI: 10.1016/j.annder.2010.06.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2010] [Revised: 05/20/2010] [Accepted: 06/22/2010] [Indexed: 11/16/2022]
Abstract
BACKGROUND Porphyria cutanea tarda (PCT) is rare in childhood and association with bone marrow transplant has occasionally been reported. PATIENTS AND METHODS A 13-year-old boy was referred to our department for bullous lesions on sun-exposed areas. His past medical history revealed acute biphenotypic leukaemia with complete remission after allogeneic hematopoietic stem cell transplantation (unrelated donor). Complications of bone marrow transplant comprised anaemia (treated by blood transfusions), primary cytomegalovirus (CMV) infection, pulmonary aspergillosis and acute digestive graft-versus-host disease. The diagnosis of type I sporadic PCT was based on high levels of porphyria and normal erythrocytic uroporphyrinogen decarboxylase activity. The bullous lesions disappeared on bleeding, but the patient subsequently developed sclerodermiform lesions. DISCUSSION An association between PCT and bone marrow transplant has been reported previously in two independent cases, of which one involved a child. The causative role of bone marrow transplantation in the development of PCT could be related to several triggering factors: primary CMV infection, hepatotoxic drugs, blood transfusion and possible chronic hepatic graft-versus-host disease. CONCLUSION We report the second case in a child of type I PCT associated with bone marrow transplantation. This new case reinforces the hypothesis of a non-random relationship between the two conditions.
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Affiliation(s)
- M Royer-Bégyn
- Hôpital Larrey et hôpital des enfants, Toulouse, France.
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Labidi J. Porphyria cutanea tarda in a chronic hemodialysis patient. Saudi J Kidney Dis Transpl 2010; 21:919-922. [PMID: 20814132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
End-stage renal failure and long-term hemodialysis (HD) treatment promote the development of genetically conditioned porphyria cutanea tarda (PCT). Iron overload is often associated with this disease and is thought to play a role in its pathogenesis. We report a case of HD-related PCT, which improved with deferoxamine treatment. A 33-year-old woman, with end-stage renal failure on HD since 1998, presented with a history of blisters on the face and dorsum of the hands, of several months duration. Laboratory analysis showed: hemoglobin 10.4 g/dL; a moderate hepatic cytolysis; ferritin 1300 μg/L (Nl: 8-120 μg/L) and negative serology for HIV, HBV and HCV. Porphyrin analyses showed a PCT pattern. Skin biopsy findings and direct immunofluorescence were consistent with PCT. The patient received deferoxamine (40 mg/kg intravenously every week for 6 weeks) which led to dramatic improvement of the symptoms. Several treatments are proposed in the management of dialysis-related PCT. This case confirms that deferoxamine can induce rapid and prolonged remission.
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Affiliation(s)
- Jannet Labidi
- Department of Internal Medicine, Hospital Militaire Principal d'instruction, Tunis, Tunisia.
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Zemtsov R, Zemtsov A. Porphyria cutanea tarda presenting as scleroderma. Cutis 2010; 85:203-205. [PMID: 20486461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Sclerodermatous skin changes were observed in a patient with porphyria cutanea tarda (PCT) who initially was diagnosed as having progressive systemic sclerosis (PSS). In extremely rare circumstances, patients with PCT initially are misdiagnosed as having generalized morphea, or PSS, because they lack the typical skin findings of PCT, such as blisters, skin fragility, scarring on the dorsal aspects of the hands, and facial hypertrichosis. However, even in cases of PCT that clinically mimic and are misdiagnosed as PSS, the sclerodermatous skin changes primarily occur in v-shaped areas of the neck. Our patient had sclerodactyly with fingertip ulcerations as well as the classic facial features and skin tightness of PSS. Upon initiation of therapeutic phlebotomy, fingertip ulcerations and sclerodactyly resolved, and there was a notable improvement of sclerodermatous skin changes of the face and forearms.
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Affiliation(s)
- Raquel Zemtsov
- University Dermatology Center, PC, Muncie, IN 47303, USA.
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Boixeda de Miquel D, Olcina JRF. [Porphyria hepatocutanea tarda]. Rev Esp Enferm Dig 2010; 102:281. [PMID: 20506607 DOI: 10.4321/s1130-01082010000400010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Muñoz-Santos C, Guilabert A, Moreno N, To-Figueras J, Badenas C, Darwich E, Herrero C. Familial and sporadic porphyria cutanea tarda: clinical and biochemical features and risk factors in 152 patients. Medicine (Baltimore) 2010; 89:69-74. [PMID: 20517178 DOI: 10.1097/md.0b013e3181d50928] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Porphyria cutanea tarda is the most frequent porphyria and occurs in both sporadic and familial forms. We conducted the current study in a series of 152 consecutive patients with porphyria cutanea tarda attending the Porphyria Unit of the Hospital Clinic of Barcelona, Spain, to update the clinical manifestations of the disease and to study the sex differences, the proportion of familial forms, and the role of different risk factors in this population. Patients were classified as familial and sporadic cases according to erythrocyte uroporphyrinogen-decarboxylase activity and uroporphyrinogen-decarboxylase genotyping. In our cohort, skin fragility and blisters on the hands were the most frequent clinical manifestations. Women more frequently had facial hypertrichosis (84.8%; p = 0.004), affected areas other than the hands and face (33.3%; p = 0.008), and pruritus (27.3%; p = 0.041) compared with men. Of our patients, 11.8% did not present the typical clinical onset of the disease, with facial hypertrichosis and hyperpigmentation the more frequent complaints in these cases. Analysis of risk factors showed a high prevalence of hepatitis C virus infection (65.8%) and alcohol abuse (59.9%), both being more frequent in men (p < 0.001). Hepatitis C virus infection was the only risk factor that showed differences between the sporadic and familial forms in the logistic regression model (odds ratio, 0.05; 95% confidence interval, 0.006-0.46). In conclusion, atypical forms of presentation of porphyria cutanea tarda should be considered in order to prevent delayed diagnosis. We note the sustained role of hepatitis C virus infection in the precipitation of sporadic porphyria cutanea tarda. Therefore, in countries with a high prevalence of hepatitis C virus infection, the absence of such infection in a patient with porphyria cutanea tarda may suggest a possible familial case.
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Affiliation(s)
- Taoufik Amezyane
- Department of Internal Medicine, Mohammed V Military Teaching Hospital, Mohammed V-Souissi University, Rabat, Morocco.
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Affiliation(s)
- Aditya Bardia
- Resident in Internal Medicine, Mayo School of Graduate Medical Education, Mayo Clinic, Rochester, MN
| | - Elizabeth A. Swanson
- Resident in Dermatology, Mayo School of Graduate Medical Education, Mayo Clinic, Rochester, MN
| | - Kris G. Thomas
- Advisor to residents and Consultant in Primary Care Internal Medicine, Mayo Clinic, Rochester, MN
- Individual reprints of this article are not available. Address correspondence to Kris G. Thomas, MD, Division of Primary Care Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905 ().
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Welsh B. Blistering skin conditions. Aust Fam Physician 2009; 38:484-490. [PMID: 19575066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Blistering of the skin can be due to a number of diverse aetiologies. Pattern and distribution of blisters can be helpful in diagnosis but usually biopsy is required for histopathology and immunofluoresence to make an accurate diagnosis. OBJECTIVE This article outlines the clinical and pathological features of blistering skin conditions with a particular focus on bullous impetigo, dermatitis herpetiformis, bullous pemphigoid and porphyria cutanea tarda. DISCUSSION Infections, contact reactions and drug eruptions should always be considered. Occasionally blistering may represent a cutaneous manifestation of a metabolic disease such as porphyria. Although rare, it is important to be aware of the autoimmune group of blistering diseases, as if unrecognised and untreated, they can lead to significant morbidity and mortality. Early referral to a dermatologist is important as management of blistering skin conditions can be challenging.
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Affiliation(s)
- Belinda Welsh
- St Vincent's Hospital, Melbourne and Sunbury Dermatology and Skin Cancer Clinic, Sunbury, Victoria.
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Barbieri L, Macrì A, Lupia Palmieri G, Aurizi C, Biolcati G. Association between porphyria cutanea tarda and beta-thalassemia major. Cell Mol Biol (Noisy-le-grand) 2009; 55:36-39. [PMID: 19656449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Accepted: 05/26/2009] [Indexed: 05/28/2023]
Abstract
The paper describes the first two cases of porphyria cutanea tarda associated with beta-thalassemia major. The clinical course of two female patients affected by beta-thalassemia major was complicated by the onset of porphyria cutanea tarda. Both patients were also suffering from hepatitis C virus infection, iron overload and anemia. We discuss about the role performed by some of these conditions in triggering overt porphyria cutanea tarda. An improvement of the clinical and biochemical picture of porphyria cutanea tarda in both patients was obtained with chloroquine therapy given that their chronic anemia did not permit phlebotomy.
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Affiliation(s)
- L Barbieri
- Struttura Semplice Dipartimentale Centro per le Porfirie e Malattie Metaboliche Ereditarie-Istituto San Gallicano, IRCCS, 00144 Rome, Italy.
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Hoffman CJ, Ray SC. Severe pruritus after completing pegylated interferon for hepatitis C. AIDS Read 2008; 18:562-565. [PMID: 19062400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Porphyria cutanea tarda is a disease of disordered accumulation of heme, which is needed for biosynthesis of hepatic cytochromes. It most commonly occurs in a sporadic form among persons infected with hepatitis C virus (HCV); however, HIV infection is also a reported risk factor. Hepatic iron overload appears to play an important role in the pathogenesis of porphyria cutanea tarda. Common cutaneous findings with porphyria cutanea tarda are vesicles or bullae, milia, and hyperpigmentation in sun-exposed areas. We report a case of porphyria cutanea tarda presenting primarily as severe pruritus in an HIV/HCV-coinfected person after completion of therapy for hepatitis C.
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Affiliation(s)
- Chistopher J Hoffman
- Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Kalivas J. Case 20-2008: Abdominal pain and weakness after gastric bypass surgery. N Engl J Med 2008; 359:1852; author reply 1852. [PMID: 18949847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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Ghosh SK, Bandyopadhyay D, Chatterjee G, Ghosh AP. Porphyria cutanea tarda. J Assoc Physicians India 2008; 56:441. [PMID: 18822623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- S K Ghosh
- Department of Dermatology, Venereology, and Leprosy, R. G. Kar Medical College, 1, Khudiram Bose Sarani, Kolkata 700 004, West Bengal, India
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Hassoun A, Corman L, Ibrahim F. Images in HIV/AIDS. An HIV-infected women with porphyria cutanea tarda. AIDS Read 2008; 18:271-272. [PMID: 18589483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Ali Hassoun
- Alabama Infectious Diseases Center, Huntsville, Alabama, USA
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Cassiman D, Vannoote J, Roelandts R, Libbrecht L, Roskams T, Van den Oord J, Fevery J, Garmyn M, Nevens F. Porphyria cutanea tarda and liver disease. A retrospective analysis of 17 cases from a single centre and review of the literature. Acta Gastroenterol Belg 2008; 71:237-242. [PMID: 18720935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND/AIMS Sporadic Porphyria Cutanea Tarda (sPCT) is associated with liver disease, e.g. HCV infection, haemochromatosis and especially alcoholic liver disease. We conducted a retrospective analysis on the prevalence of liver disorders in association with Porphyria Cutanea Tarda (PCT), in a university referral centre. METHODS The PCT cases were retrieved from computerized databases. Patient files lacking information on the presence of concomitant liver disease were excluded from further analysis. RESULTS 29 PCT patients were retrieved from our databases, of which 17 patients with sPCT were retained for further analysis. Patients were middle aged (mean age: 43 +/- 3) and there was no gender difference (10 males vs. 7 females). Almost all patients had iron overload (14/17). 5 patients had chronic HCV, with type 1b in 3 of them, 7 abused alcohol, 4 patients had hereditary haemochromatosis (3 homozygous C282Y--1 heterozygous H63D/C282Y). In 3 patients sPCT was associated with medication intake and one patient had chronic hepatitis B (HBV). 13 patients were treated with phlebotomies, with success in 11/13. 4 patients were treated with chloroquine, 3 of which also underwent phlebotomies. Of the 5 patients with HCV, 3 were successfully treated with combined antiviral therapy; one of them is planned to be treated; one patient never received therapy and was lost from follow-up. One patient developed hepatocellular carcinoma (HCC) during a median follow-up of 24 years. CONCLUSIONS We found a significant association between sPCT and liver disorders, such as chronic HCV infection, alcohol abuse, iron overload and hereditary haemochromatosis. Therefore, patients presenting with PCT should be screened for concomitant liver disease. Iron overload is present in a majority of patients, the majority of patients can be successfully treated with phlebotomies. The risk of developing HCC in our sPCT patients and in literature is low.
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Affiliation(s)
- David Cassiman
- Department of Hepatology, University Hospital Gasthuisberg, University of Leuven, Belgium.
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Stokes KI. Strange bedfellows. J Miss State Med Assoc 2007; 48:337-339. [PMID: 19292132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Keith I Stokes
- Department of Family Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA.
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Young LC. Porphyria cutanea tarda associated with Cys282Tyr mutation in HFE gene in hereditary hemochromatosis: a case report and review of the literature. Cutis 2007; 80:415-418. [PMID: 18189029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Porphyria cutanea tarda (PCT) typically presents with complaints of fragile skin, dorsal hand vesicles, erosions, and scars, and increased levels of uroporphyrins. A case of PCT caused by iron overload associated with hereditary hemochromatosis (HH) is reported. The laboratory workup revealed the patient was homozygous for the Cys282Tyr mutation in the HFE (hemochromatosis) gene. The associated diagnosis of HH was critical because without early treatment, damage to vital organs and premature death could occur. This report highlights the important association of PCT with HH and reviews the role of key genetic and hormonal factors in iron regulation.
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Affiliation(s)
- Lorraine C Young
- Department of Medicine, Division of Dermatology, David Geffen School of Medicine, University of California, Los Angeles 90095, USA.
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Volksbeck SIL, Nashan D, Bruckner-Tuderman L, Braun-Falco M. Localized sclerosis of the scalp (alopecia porphyrinica) as predominant presentation of porphyria cutanea tarda. J Eur Acad Dermatol Venereol 2007; 21:1125-7. [PMID: 17714148 DOI: 10.1111/j.1468-3083.2006.02113.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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