Porphyria cutanea tarda in a chronic hemodialysis patient: A case report and review of the literature.
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Porphyria cutanea tarda (PCT) is becoming increasingly recognized as a complication of hemodialysis. More than 25 patients with PCT during maintenance hemodialysis have been reported in literature since 1975. We report an additional case in which there is both clinical and biochemical evidence of PCT, with onset during hemodialysis for chronic renal failure.<BR>(Report of a case) A 38-year-old woman with chronic renal failure was started on chronic hemodialysis in October 1986. In July 1987 she noticed hyperpigmentation, skin fragility, and multiple bullae on her face and dorsum of her hands. Physical examination revealed hyperpigmentation, blisters, crusts and scars in the sun exposed area of the face, the hands and the arms. A biopsy of a blister showed PAS-positive deposits limited to the immediate vicinity of the blood vessels in the papillary dermis. Laboratory studies reflected chronic renal failure with anemia and uremia. There was no evidence of chronic liver disease. Serum iron was normal. Porphyrin studies were performed on plasma, urine and stool, and showed a pattern consistent with PCT.<BR>(Comment) There was both clinical and biochemical evidence of PCT in this case. She had no history of alcohol abuse or liver disease. There was no family history of porphyria, seizures, abdominal pains or cutaneous photosensitivity. She did not take the following medications: iron, estrogens and barbiturates. Therefore, hemodialysis seemed to be causative in this case.<BR>The occurrence of porphyria cutanea tarda during chronic hemodialysis for chronic renal failure is rare and the inducing mechanisms for PCT in these patients are uncertain.
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