[Porphyria cutanea tarda in a chronic hemodialysis patient]

After 6 months on hemodialysis, a 58-year-old male patient with diabetes developed photosensitive bullous dermatosis on his hands and face. There was no evidence of liver diseases although the patient had a history of excessive alcohol consumption. He was suspected to have iron overload in the liver. Analysis of porphyrins in plasma, hemofiltrate, urine and feces by high performance liquid chromatography revealed significantly high levels in these samples with a porphyrin profiles which is consistent with porphyria cutanea tarda. The fluorometric assays of plasma also disclosed an elevated plasma porphyrin level. And it seemed that there were correlation between the fluctuation of vesicle formation, serum ferritin level and plasma porphyrin level. Small volume plasma exchange temporarily reduced the plasma porphyrin level and prevented vesicle formation.